Air Pollution in Relation to COVID-19 Morbidity and Mortality: A Large Population-Based Cohort Study in Catalonia, Spain (COVAIR-CAT).

Evidence from epidemiological studies based on individual-level data indicates that air pollution may be associated with coronavirus disease 2019 (COVID-19) severity. We aimed to test whether (1) long-term exposure to air pollution is associated with COVID-19-related hospital admission or mortality in the general population; (2) short-term exposure to air pollution is associated with COVID-19-related hospital admission following COVID-19 diagnosis; (3) there are vulnerable population subgroups; and (4) the influence of long-term air pollution exposure on COVID-19-related hospital admissions differed from that for other respiratory infections. We constructed a cohort covering nearly the full population of Catalonia through registry linkage, with follow- up from January 1, 2015, to December 31, 2020. Exposures at residential addresses were estimated using newly developed spatiotemporal models of nitrogen dioxide (NO The general population cohort included 4,660,502 individuals; in 2020 there were 340,608 COVID-19 diagnoses, 47,174 COVID-19-related hospital admissions, and 10,001 COVID-19 deaths. Mean (standard deviation) annual exposures were 26.2 (10.3) μg/m Linkage across several registries allowed the construction of a large population-based cohort, tracking COVID-19 cases from primary care and testing data to hospital admissions, and death. Long- and short-term exposure to ambient air pollution were positively associated with severe COVID-19 events. The effects of long-term air pollution exposure on COVID-19 severity were greater among those with lower individual- and area-level SES.

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