Association of Short-term Air Pollution Exposure With SARS-CoV-2 Infection Among Young Adults in Sweden

JAMA Netw Open. 2022 Apr 1;5(4):e228109. doi: 10.1001/jamanetworkopen.2022.8109.


Importance: Mounting ecological evidence shows an association between short-term air pollution exposure and COVID-19, yet no study has examined this association on an individual level.

Objective: To estimate the association between short-term exposure to ambient air pollution and SARS-CoV-2 infection among Swedish young adults.

Design, setting, and participants: This time-stratified case-crossover study linked the prospective BAMSE (Children, Allergy Milieu, Stockholm, Epidemiology [in Swedish]) birth cohort to the Swedish national infectious disease registry to identify cases with positive results for SARS-CoV-2 polymerase chain reaction (PCR) testing from May 5, 2020, to March 31, 2021. Case day was defined as the date of the PCR test, whereas the dates with the same day of the week within the same calendar month and year were selected as control days. Data analysis was conducted from September 1 to December 31, 2021.

Exposures: Daily air pollutant levels (particulate matter with diameter ≤2.5 μm [PM2.5], particulate matter with diameter ≤10 μm [PM10], black carbon [BC], and nitrogen oxides [NOx]) at residential addresses were estimated using dispersion models with high spatiotemporal resolution.

Main outcomes and measures: Confirmed SARS-CoV-2 infection among participants within the BAMSE cohort. Distributed-lag models combined with conditional logistic regression models were used to estimate the association.

Results: A total of 425 cases were identified, of whom 229 (53.9%) were women, and the median age was 25.6 (IQR, 24.9-26.3) years. The median exposure level for PM2.5 was 4.4 [IQR, 2.6-6.8] μg/m3 on case days; for PM10, 7.7 [IQR, 4.6-11.3] μg/m3 on case days; for BC, 0.3 [IQR, 0.2-0.5] μg/m3 on case days; and for NOx, 8.2 [5.6-14.1] μg/m3 on case days. Median exposure levels on control days were 3.8 [IQR, 2.4-5.9] μg/m3 for PM2.5, 6.6 [IQR, 4.5-10.4] μg/m3 for PM10, 0.2 [IQR, 0.2-0.4] μg/m3 for BC, and 7.7 [IQR, 5.3-12.8] μg/m3 for NOx. Each IQR increase in short-term exposure to PM2.5 on lag 2 was associated with a relative increase in positive results of SARS-CoV-2 PCR testing of 6.8% (95% CI, 2.1%-11.8%); exposure to PM10 on lag 2, 6.9% (95% CI, 2.0%-12.1%); and exposure to BC on lag 1, 5.8% (95% CI, 0.3%-11.6%). These findings were not associated with NOx, nor were they modified by sex, smoking, or having asthma, overweight, or self-reported COVID-19 respiratory symptoms.

Conclusions and relevance: The findings of this case-crossover study of Swedish young adults suggest that short-term exposure to particulate matter and BC was associated with increased risk of positive PRC test results for SARS-CoV-2, supporting the broad public health benefits of reducing ambient air pollution levels.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Air Pollution* / adverse effects
  • Air Pollution* / analysis
  • COVID-19* / epidemiology
  • Child
  • Cross-Over Studies
  • Environmental Exposure / adverse effects
  • Environmental Exposure / analysis
  • Female
  • Humans
  • Male
  • Nitrogen Oxides / analysis
  • Particulate Matter / adverse effects
  • Particulate Matter / analysis
  • Prospective Studies
  • SARS-CoV-2
  • Sweden / epidemiology
  • Young Adult


  • Nitrogen Oxides
  • Particulate Matter