Ranzani, OtavioAlari, AnnaOlmos, SergioMilà, CarlesRico, AlexBallester, JoanBasagaña Flores, XavierChaccour, CarlosDadvand, PayamDuarte Salles, Talita, 1985-Foraster Pulido, Maria, 1984-Nieuwenhuijsen, Mark J.Sunyer Deu, JordiValentín, AntòniaKogevinas, ManolisLazcano Dobao, UxueAvellaneda Gómez, CarlaVivanco Hidalgo, Rosa MaríaTonne, Cathryn2023-09-012023-09-012023Ranzani O, Alari A, Olmos S, Milà C, Rico A, Ballester J, Basagaña X, Chaccour C, Dadvand P, Duarte-Salles T, Foraster M, Nieuwenhuijsen M, Sunyer J, Valentín A, Kogevinas M, Lazcano U, Avellaneda-Gómez C, Vivanco R, Tonne C. Long-term exposure to air pollution and severe COVID-19 in Catalonia: a population-based cohort study. Nat Commun. 2023;14:2916. DOI: 10.1038/s41467-023-38469-72041-1723http://hdl.handle.net/10230/57792The association between long-term exposure to ambient air pollutants and severe COVID-19 is uncertain. We followed 4,660,502 adults from the general population in 2020 in Catalonia, Spain. Cox proportional models were fit to evaluate the association between annual averages of PM2.5, NO2, BC, and O3 at each participant's residential address and severe COVID-19. Higher exposure to PM2.5, NO2, and BC was associated with an increased risk of COVID-19 hospitalization, ICU admission, death, and hospital length of stay. An increase of 3.2 µg/m3 of PM2.5 was associated with a 19% (95% CI, 16-21) increase in hospitalizations. An increase of 16.1 µg/m3 of NO2 was associated with a 42% (95% CI, 30-55) increase in ICU admissions. An increase of 0.7 µg/m3 of BC was associated with a 6% (95% CI, 0-13) increase in deaths. O3 was positively associated with severe outcomes when adjusted by NO2. Our study contributes robust evidence that long-term exposure to air pollutants is associated with severe COVID-19.application/pdfeng© The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.info:eu-repo/semantics/articlehttp://dx.doi.org/10.1038/s41467-023-38469-7EpidemiologyOutcomes researchSARS-CoV-2info:eu-repo/semantics/openAccess