Associations of long-term exposure to air pollution and greenness with COVID-19 prevalence in Northern Europe

Xu, Shanshan ; Marcon, Alessandro ; Bertelsen, Randi Jacobsen; Benediktsdottir, Bryndis; Brandt, Jørgen ; Frohn, Lise Marie ; Geels, Camilla ; Gislason, Thorarinn ; Heinrich, Joachim ; Holm, Mathias ; Janson, Christer ; Markevych, Iana ; Modig, Lars; Orru, Hans; Schlünssen, Vivi; Sigsgaard, Torben und Johannessen, Ane (2025): Associations of long-term exposure to air pollution and greenness with COVID-19 prevalence in Northern Europe. ERS: European Respiratory Society Congress 2025, Amsterdam, 07. September - 01. Oktober 2025. European Respiratory Journal. Vol. 66, No. Supplement 69, PA4729 Lausanne: European Respiratory Society.

Abstract

Background: Air pollution may be linked to an increased risk of COVID-19 infection, while evidence concerning the effects of greenness on COVID-19 remains sparse.

Aim: We investigated the associations between long-term exposure to air pollution and greenness with self-reported COVID-19 prevalence in the Respiratory Health in Northern Europe (RHINE IV) study.

Methods: COVID-19 prevalence data of adults (aged 49-76) were obtained from the RHINE IV survey (from 2021-2023). Exposure data for 2010 were retrieved for residential addresses, where we estimated annual mean residential exposure to particulate matter (PM2.5 and PM10), elemental carbon (EC), and nitrogen dioxide (NO2) using a dispersion model. Residential greenness was derived from the satellite-based Normalized Difference Vegetation Index (NDVI) with a 300m buffer zone. Logistic regression was used to evaluate the associations between exposure to air pollution, greenness, and COVID-19 prevalence, adjusting for age, sex, study center, and education.

Results: Of 6,387 participants, 1,021 reported having had COVID-19. Adjusted odds ratios (ORs) and 95% confidence intervals for COVID-19 prevalence, calculated for an interquartile range (IQR) increase, were 1.04 (0.85-1.28) per 3.84 µg/m³ for PM2.5, 1.11 (0.95-1.29) per 5.73 µg/m³ for PM10, 1.34 (1.07-1.69) per 0.45 µg/m³ for EC, and 1.11 (1.00-1.25) per 8.86 µg/m³ for NO2. In contrast, higher exposure to NDVI was associated with reduced odds of COVID-19, with an OR of 0.87 (0.76–0.99) per 0.18-unit increase.

Conclusion: Long-term exposure to EC and NO2 was associated with increased prevalence of COVID-19, while long-term exposure to higher greenness showed a decreased risk.

• Item Type: Conference or Workshop Item (Speech)
• Faculties: Medicine > Institute and Polyclinic for Occupational, Social and Environmental Medicine
• Subjects: 600 Technology > 610 Medicine and health
• Place of Publication: Lausanne
• Annotation: This article was presented at the 2025 ERS Congress, in session “Role of pollution, pollen and microbiota in respiratory diseases”.
• Language: English