Long-Term Exposure to Air Pollution and COVID-19 Vaccine Antibody Response in a General Population Cohort (COVICAT Study, Catalonia)

Background: Ambient air pollution has been associated with COVID-19 disease severity and antibody response induced by infection.

Objectives: We examined the association between long-term exposure to air pollution and vaccine-induced antibody response.

Methods: This study was nested in an ongoing population-based cohort, COVICAT, the GCAT-Genomes for Life cohort, in Catalonia, Spain, with multiple follow-ups. We drew blood samples in 2021 from 1,090 participants of 2,404 who provided samples in 2020, and we included 927 participants in this analysis. We measured immunoglobulin M (IgM), IgG, and IgA antibodies against five viral-target antigens, including receptor-binding domain (RBD), spike-protein (S), and segment spike-protein (S2) triggered by vaccines available in Spain. We estimated prepandemic (2018-2019) exposure to fine particulate matter [PM $\le 2.5\mu m$ in aerodynamic diameter (${\mathrm{PM}}_{2.5}$)], nitrogen dioxide (${\mathrm{NO}}_2$), black carbon (BC), and ozone ($O_3$) using Effects of Low-Level Air Pollution: A Study in Europe (ELAPSE) models. We adjusted estimates for individual- and area-level covariates, time since vaccination, and vaccine doses and type and stratified by infection status. We used generalized additive models to explore the relationship between air pollution and antibodies according to days since vaccination.

Results: Among vaccinated persons not infected by SARS-CoV-2 ($n=632$), higher prepandemic air pollution levels were associated with a lower vaccine antibody response for IgM (1 month post vaccination) and IgG. Percentage change in geometric mean IgG levels per interquartile range of ${\mathrm{PM}}_{2.5}$ ($1.7{\mu g/m}^3$) were $-8.1$ (95% CI: $-15.9$, 0.4) for RBD, $-9.9$ ($-16.2$, $-3.1$) for S, and $-8.4$ ($-13.5$, $-3.0$) for S2. We observed a similar pattern for ${\mathrm{NO}}_2$ and BC and an inverse pattern for $O_3$. Differences in IgG levels by air pollution levels persisted with time since vaccination. We did not observe an association of air pollution with vaccine antibody response among participants with prior infection ($n=295$).

Discussion: Exposure to air pollution was associated with lower COVID-19 vaccine antibody response. The implications of this association on the risk of breakthrough infections require further investigation. https://doi.org/10.1289/EHP11989.