Environmental, climatic, socio-economic factors and non-pharmacological interventions: A comprehensive four-domain risk assessment of COVID-19 hospitalization and death in Northern Italy

Lucia Palandri; Cristiana Rizzi; Vittoria Vandelli; Tommaso Filippini; Alessandro Ghinoi; Giuliano Carrozzi; Gianfranco De Girolamo; Isabella Morlini; Paola Coratza; Enrico Giovannetti; Margherita Russo; Mauro Soldati; Elena Righi; DISCOV-19 study group

doi:10.1016/j.ijheh.2024.114471

Environmental, climatic, socio-economic factors and non-pharmacological interventions: A comprehensive four-domain risk assessment of COVID-19 hospitalization and death in Northern Italy

Int J Hyg Environ Health. 2024 Oct 3:263:114471. doi: 10.1016/j.ijheh.2024.114471. Online ahead of print.

Collaborators

DISCOV-19 study group:
Daniela Azzalini, Riccardo Barbieri, Petra Bechtold, Lucia Borsari, Giacomo Creola, Alberto Ferrari, Davide Ferrari, Eleonora Ferrari, Elisabetta Fioretti, Maria Giulia Gatti, Laura Iacuzio, Ramona Iseppi, Camilla Lugli, Marco Monti, Marcello Morciano

Affiliations

¹ Department of Biomedical, Metabolic and Neural Sciences, Section of Public Health, University of Modena and Reggio Emilia, Modena, Italy; PhD Program in Clinical and Experimental Medicine, Department of Biomedical, Metabolic and Neural Sciences, Section of Public Health, University of Modena and Reggio Emilia, Modena, Italy.
² Department of Biomedical, Metabolic and Neural Sciences, Section of Public Health, University of Modena and Reggio Emilia, Modena, Italy.
³ Department of Chemical and Geological Sciences, University of Modena and Reggio Emilia, Modena, Italy.
⁴ Department of Biomedical, Metabolic and Neural Sciences, Section of Public Health, University of Modena and Reggio Emilia, Modena, Italy; Environmental, Genetic and Nutritional Epidemiology Research Center (CREAGEN), Department of Biomedical, Metabolic and Neural Sciences, Section of Public Health, University of Modena and Reggio Emilia, Modena, Italy; School of Public Health, University of California Berkeley, Berkeley, CA, USA. Electronic address: tommaso.filippini@unimore.it.
⁵ Epidemiology and Risk Communication Service, Department of Public Health, Local Health Authority of Modena, Modena, Italy.
⁶ Department of Communication and Economics, University of Modena and Reggio Emilia, Reggio Emilia, Italy.
⁷ Marco Biagi Department of Economics, University of Modena and Reggio Emilia, Modena, Italy.

PMID: 39366078
DOI: 10.1016/j.ijheh.2024.114471

Abstract

Introduction: Up to now, studies on environmental, climatic, socio-economic factors, and non-pharmacological interventions (NPI) show diverse associations, often contrasting, with COVID-19 spread or severity. Most studies used large-scale, aggregated data, with limited adjustment for individual factors, most of them focused on viral spread than severe outcomes. Moreover, evidence simultaneously evaluating variables belonging to different exposure domains is scarce, and none analysing their collective impact on an individual level.

Methods: Our population-based retrospective cohort study aimed to assess the comprehensive role played by exposure variables belonging to four different domains, environmental, climatic, socio-economic, and non-pharmacological interventions (NPI), on individual COVID-19-related risk of hospitalization and death, analysing data from all patients (no. 68472) tested positive to a SARS-CoV-2 swab in Modena Province (Northern Italy) between February 2020 and August 2021. Using adjusted Cox proportional hazard models, we estimated the risk of severe COVID-19 outcomes, investigating dose-response relationships through restricted cubic spline modelling for hazard ratios.

Results: Several significant associations emerged: long-term exposure to air pollutants (NO₂, PM₁₀, PM_2.5) was linked to hospitalization risk in a complex way and showed an increased risk for death; while humidity was inversely associated; temperature showed a U-shaped risk; wind speed showed a linear association with both outcomes. Precipitation increased hospitalization risk but decreased mortality. Socio-economic and NPI indices showed clear linear associations, respectively negative and positive, with both outcomes.

Conclusions: Our findings offer insights for evidence-based policy decisions, improving precision healthcare practices, and safeguarding public health in future pandemics. Refinement of pandemic response plans by healthcare authorities could benefit significantly.

Keywords: COVID-19 outcomes; Containment and health index; Deprivation index; Environmental and climate factors; Italy; Restrictive measures.