Exposure to air pollution and hospitalization due to COVID-19 in São José dos Campos, Brazil

The association between exposure to air pollutants and respiratory diseases is well known. This study aimed to identify the association between this exposure and hospitalizations for COVID-19 in São José dos Campos, SP, a medium-sized city, between April 2020 and April 2021. Hospitalization data, concerning code B34.2, was supplied by DATASUS, and data concerning pollutants and climate variables were supplied by CETESB. Cases were quantified by sex, age, length of hospital stay in days, and type of discharge, whether hospital discharge or death. The negative binomial regression model was chosen. Estimates were produced for the relative risk (RR) of significant exposure to pollutants (P≤0.05) with a 10 µg/m3 increase of pollutant, as well as for excess hospitalizations. There were 1873 hospitalizations, with a daily average of 4.7 (±3.8), ranging from zero to 21: 716 deaths (38.2%) were recorded, 1065 admissions were men, and women were less susceptible (OR=0.82). The average age of women was higher than that of men; in cases of death, men were older than women; discharged patients were younger. All the above variables were significant. The risk of ozone exposure was higher and more significant in Lag 2, and the risk of nitrogen dioxide exposure was high in Lag 3, which was the period of the highest increase in hospitalizations, at 11.3%. The findings of this study, the first conducted in Brazil, corroborate the results of studies conducted in other centers.

大气污染物暴露与呼吸系统疾病的关联已得到学界广泛认可。本研究旨在探明2020年4月至2021年4月期间，中型城市圣保罗州圣若泽杜斯坎普斯（São José dos Campos, SP）内，新冠病毒病（COVID-19）住院情况与大气污染物暴露之间的关联。本研究中，对应国际疾病分类（ICD-10）编码B34.2的新冠住院数据由DATASUS提供，污染物及气候变量数据由CETESB提供。研究对象按性别、年龄、住院时长（天）以及转归类型（出院或死亡）进行量化统计。本研究选用负二项回归模型开展分析，针对每10 µg/m³的污染物浓度升高所对应的显著暴露的相对危险度（relative risk, RR，P≤0.05），以及超额住院风险，均进行了估算。本次研究共纳入1873例住院病例，日均住院量为4.7例（标准差±3.8），区间范围为0至21例；其中记录死亡716例，占比38.2%；男性住院患者共1065例，女性易感性更低（比值比OR=0.82）。女性患者平均年龄高于男性；死亡病例中男性平均年龄高于女性；出院患者平均年龄则更低，上述所有变量均具有统计学显著性。臭氧暴露的风险在滞后2阶（Lag 2）更高且统计学显著性更强；二氧化氮暴露的风险在滞后3阶（Lag 3）较高，该时期对应住院量增幅最高的阶段，增幅达11.3%。本研究作为巴西境内开展的首项同类研究，其结果与其他地区相关研究的结论一致。