Long-Term Exposure to Particulate Air Pollution and SARS-CoV-2 Infections and COVID-19 Deaths in California, U.S.A

Rationale: Previous studies have reported associations between air pollution and COVID-19 morbidity and mortality, but most have limited their exposure assessment to a large area, have not used individual-level variables, nor studied infections. Objectives: We examined 3.1 million SARS-CoV-2 infections and 49,691 COVID-19 deaths that occurred in California from February 2020 to February 2021 to evaluate risks associated with long-term neighborhood levels of particulate matter less than 2.5 mm in diameter (PM2.5). Methods: We obtained individual address data on SARS-CoV-2 infections and COVID-19 deaths and assigned 2000-2018 1km x 1km gridded PM2.5 surfaces to census block groups. We included individual covariate data on age and sex, and census block data on race/ethnicity, air basin, Area Deprivation Index, and relevant comorbidities. Our analyses were based on generalized linear mixed models utilizing a Poisson distribution. Measurements and Main Results: Those living in the highest quintile of long-term PM2.5 exposure had risks of SARS-CoV-2 infections 20% higher and risks of COVID-19 mortality 51% higher, compared to those living in the lowest quintile of long-term PM2.5 exposure. Those living in the areas of highest long-term PM2.5 exposure were more likely to be Hispanic and more vulnerable, based on the Area Deprivation Index. Conclusions: The increased risks for SARS-CoV-2 Infections and COVID-19 mortality associated with highest long-term PM2.5 levels at the neighborhood-level in California were consistent with a growing body of literature from studies worldwide, and further highlight the importance of reducing levels of air pollution to protect public health.