Ambient air pollution and COVID-19 risk: Evidence from 35 observational studies

The coronavirus disease 2019 (COVID-19) pandemic is severely threatening and challenging public health worldwide. Epidemiological studies focused on the influence of outdoor air pollution (AP) on COVID-19 risk have produced inconsistent conclusions. We aimed to quantitatively explore this association using a meta-analysis.

We searched for studies related to outdoor AP and COVID-19 risk in the Embase, PubMed, and Web of Science databases. No language restriction was utilized. The search date entries were up to August 13, 2021. Pooled estimates and 95% confidence intervals (CIs) were obtained with random-/fixed-effects models. PROSPERO registration number: CRD42021244656.

A total of 35 articles were eligible for the meta-analysis. For long-term exposure to AP, COVID-19 incidence was positively associated with 1 μg/m³ increase in nitrogen dioxide (NO₂; effect size = 1.042, 95% CI 1.017-1.068), particulate matter with diameter <2.5 μm (PM_2.5; effect size = 1.056, 95% CI 1.039-1.072), and sulfur dioxide (SO₂; effect size = 1.071, 95% CI 1.002-1.145). The COVID-19 mortality was positively associated with 1 μg/m³ increase in nitrogen dioxide (NO₂; effect size = 1.034, 95% CI 1.006-1.063), PM_2.5 (effect size = 1.047, 95% CI 1.025-1.1071). For short-term exposure to air pollutants, COVID-19 incidence was positively associated with 1 unit increase in air quality index (effect size = 1.001, 95% CI 1.001-1.002), 1 μg/m³ increase NO₂ (effect size = 1.014, 95% CI 1.011-1.016), particulate matter with diameter <10 μm (PM₁₀; effect size = 1.005, 95% CI 1.003-1.008), PM_2.5 (effect size = 1.003, 95% CI 1.002-1.004), and SO₂ (effect size = 1.015, 95% CI 1.007-1.023).

Outdoor air pollutants are detrimental factors to COVID-19 outcomes. Measurements beneficial to reducing pollutant levels might also reduce the burden of the pandemic.