Ambient air pollution exposure linked to long COVID among young adults: a nested survey in a population-based cohort in Sweden
Post COVID-19 conditions, also known as long COVID, are of public health concern, but little is known about their underlying risk factors. We aimed to investigate associations of air pollution exposure with long COVID among Swedish young adults. We used data from the BAMSE (Children, Allergy, Enviro...
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Veröffentlicht in: | The Lancet regional health. Europe 2023-05, Vol.28, p.100608-100608, Article 100608 |
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creator | Yu, Zhebin Ekström, Sandra Bellander, Tom Ljungman, Petter Pershagen, Göran Eneroth, Kristina Kull, Inger Bergström, Anna Georgelis, Antonios Stafoggia, Massimo Gruzieva, Olena Melén, Erik Almqvist, Catarina Andersson, Niklas Ballardini, Natalia Bergström, Anna Björkander, Sophia Brodin, Petter Castel, Anna Ekström, Sandra Georgelis, Antonios Hammarström, Lennart Pan-Hammarström, Qiang Hallberg, Jenny Jansson, Christer Kere, Maura Kull, Inger Lauber, André Lövquist, Alexandra Melén, Erik Mjösberg, Jenny Mogensen, Ida Palmberg, Lena Pershagen, Göran Roxhed, Niclas Schwenk, Jochen |
description | Post COVID-19 conditions, also known as long COVID, are of public health concern, but little is known about their underlying risk factors. We aimed to investigate associations of air pollution exposure with long COVID among Swedish young adults.
We used data from the BAMSE (Children, Allergy, Environment, Stockholm, Epidemiology [in Swedish]) cohort. From October 2021 to February 2022 participants answered a web-questionnaire focusing on persistent symptoms following acute SARS-CoV-2 infection. Long COVID was defined as symptoms after confirmed infection with SARS-CoV-2 lasting for two months or longer. Ambient air pollution levels (particulate matter ≤2.5 μm [PM2.5], ≤10 μm [PM10], black carbon [BC] and nitrogen oxides [NOx]) at individual-level addresses were estimated using dispersion modelling.
A total of 753 participants with SARS-CoV-2 infection were included of whom 116 (15.4%) reported having long COVID. The most common symptoms were altered smell/taste (n = 80, 10.6%), dyspnea (n = 36, 4.8%) and fatigue (n = 34, 4.5%). Median annual PM2.5 exposure in 2019 (pre-pandemic) was 6.39 (interquartile range [IQR] 6.06–6.71) μg/m3. Adjusted Odds Ratios (95% confidence intervals) of PM2.5 per IQR increase were 1.28 (1.02–1.60) for long COVID, 1.65 (1.09–2.50) for dyspnea symptoms and 1.29 (0.97–1.70) for altered smell/taste. Positive associations were found for the other air pollutants and remained consistent across sensitivity analyses. Associations tended to be stronger among participants with asthma, and those having had COVID during 2020 (versus 2021).
Ambient long-term PM2.5 exposure may affect the risk of long COVID in young adults, supporting efforts for continuously improving air quality.
The study received funding from the Swedish Research Council (grant no. 2020-01886, 2022-06340), the Swedish Research Council for Health, Working life and Welfare (FORTE grant no. 2017-01146), the Swedish Heart-Lung Foundation, Karolinska Institute (no. 2022-01807) and Region Stockholm (ALF project for cohort and database maintenance). |
doi_str_mv | 10.1016/j.lanepe.2023.100608 |
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We used data from the BAMSE (Children, Allergy, Environment, Stockholm, Epidemiology [in Swedish]) cohort. From October 2021 to February 2022 participants answered a web-questionnaire focusing on persistent symptoms following acute SARS-CoV-2 infection. Long COVID was defined as symptoms after confirmed infection with SARS-CoV-2 lasting for two months or longer. Ambient air pollution levels (particulate matter ≤2.5 μm [PM2.5], ≤10 μm [PM10], black carbon [BC] and nitrogen oxides [NOx]) at individual-level addresses were estimated using dispersion modelling.
A total of 753 participants with SARS-CoV-2 infection were included of whom 116 (15.4%) reported having long COVID. The most common symptoms were altered smell/taste (n = 80, 10.6%), dyspnea (n = 36, 4.8%) and fatigue (n = 34, 4.5%). Median annual PM2.5 exposure in 2019 (pre-pandemic) was 6.39 (interquartile range [IQR] 6.06–6.71) μg/m3. Adjusted Odds Ratios (95% confidence intervals) of PM2.5 per IQR increase were 1.28 (1.02–1.60) for long COVID, 1.65 (1.09–2.50) for dyspnea symptoms and 1.29 (0.97–1.70) for altered smell/taste. Positive associations were found for the other air pollutants and remained consistent across sensitivity analyses. Associations tended to be stronger among participants with asthma, and those having had COVID during 2020 (versus 2021).
Ambient long-term PM2.5 exposure may affect the risk of long COVID in young adults, supporting efforts for continuously improving air quality.
The study received funding from the Swedish Research Council (grant no. 2020-01886, 2022-06340), the Swedish Research Council for Health, Working life and Welfare (FORTE grant no. 2017-01146), the Swedish Heart-Lung Foundation, Karolinska Institute (no. 2022-01807) and Region Stockholm (ALF project for cohort and database maintenance).</description><identifier>ISSN: 2666-7762</identifier><identifier>EISSN: 2666-7762</identifier><identifier>DOI: 10.1016/j.lanepe.2023.100608</identifier><identifier>PMID: 37131862</identifier><language>eng</language><publisher>England: Elsevier Ltd</publisher><subject>Air pollution ; Long COVID ; PM2.5 ; Young adults</subject><ispartof>The Lancet regional health. Europe, 2023-05, Vol.28, p.100608-100608, Article 100608</ispartof><rights>2023 The Author(s)</rights><rights>2023 The Author(s).</rights><rights>2023 The Author(s) 2023</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c501t-e94c8ec88ef83d3d0ab07b7d092b3916affd822da8c0e4cebc165b518978c8913</citedby><cites>FETCH-LOGICAL-c501t-e94c8ec88ef83d3d0ab07b7d092b3916affd822da8c0e4cebc165b518978c8913</cites><orcidid>0000-0001-9392-5624 ; 0000-0002-0657-1512</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC9989696/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC9989696/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,550,723,776,780,860,881,27901,27902,53766,53768</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37131862$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttp://kipublications.ki.se/Default.aspx?queryparsed=id:154301209$$DView record from Swedish Publication Index$$Hfree_for_read</backlink></links><search><creatorcontrib>Yu, Zhebin</creatorcontrib><creatorcontrib>Ekström, Sandra</creatorcontrib><creatorcontrib>Bellander, Tom</creatorcontrib><creatorcontrib>Ljungman, Petter</creatorcontrib><creatorcontrib>Pershagen, Göran</creatorcontrib><creatorcontrib>Eneroth, Kristina</creatorcontrib><creatorcontrib>Kull, Inger</creatorcontrib><creatorcontrib>Bergström, Anna</creatorcontrib><creatorcontrib>Georgelis, Antonios</creatorcontrib><creatorcontrib>Stafoggia, Massimo</creatorcontrib><creatorcontrib>Gruzieva, Olena</creatorcontrib><creatorcontrib>Melén, Erik</creatorcontrib><creatorcontrib>Almqvist, Catarina</creatorcontrib><creatorcontrib>Andersson, Niklas</creatorcontrib><creatorcontrib>Ballardini, Natalia</creatorcontrib><creatorcontrib>Bergström, Anna</creatorcontrib><creatorcontrib>Björkander, Sophia</creatorcontrib><creatorcontrib>Brodin, Petter</creatorcontrib><creatorcontrib>Castel, Anna</creatorcontrib><creatorcontrib>Ekström, Sandra</creatorcontrib><creatorcontrib>Georgelis, Antonios</creatorcontrib><creatorcontrib>Hammarström, Lennart</creatorcontrib><creatorcontrib>Pan-Hammarström, Qiang</creatorcontrib><creatorcontrib>Hallberg, Jenny</creatorcontrib><creatorcontrib>Jansson, Christer</creatorcontrib><creatorcontrib>Kere, Maura</creatorcontrib><creatorcontrib>Kull, Inger</creatorcontrib><creatorcontrib>Lauber, André</creatorcontrib><creatorcontrib>Lövquist, Alexandra</creatorcontrib><creatorcontrib>Melén, Erik</creatorcontrib><creatorcontrib>Mjösberg, Jenny</creatorcontrib><creatorcontrib>Mogensen, Ida</creatorcontrib><creatorcontrib>Palmberg, Lena</creatorcontrib><creatorcontrib>Pershagen, Göran</creatorcontrib><creatorcontrib>Roxhed, Niclas</creatorcontrib><creatorcontrib>Schwenk, Jochen</creatorcontrib><creatorcontrib>the BAMSE COVID-19 Study Group</creatorcontrib><creatorcontrib>BAMSE COVID-19 Study Group</creatorcontrib><title>Ambient air pollution exposure linked to long COVID among young adults: a nested survey in a population-based cohort in Sweden</title><title>The Lancet regional health. Europe</title><addtitle>Lancet Reg Health Eur</addtitle><description>Post COVID-19 conditions, also known as long COVID, are of public health concern, but little is known about their underlying risk factors. We aimed to investigate associations of air pollution exposure with long COVID among Swedish young adults.
We used data from the BAMSE (Children, Allergy, Environment, Stockholm, Epidemiology [in Swedish]) cohort. From October 2021 to February 2022 participants answered a web-questionnaire focusing on persistent symptoms following acute SARS-CoV-2 infection. Long COVID was defined as symptoms after confirmed infection with SARS-CoV-2 lasting for two months or longer. Ambient air pollution levels (particulate matter ≤2.5 μm [PM2.5], ≤10 μm [PM10], black carbon [BC] and nitrogen oxides [NOx]) at individual-level addresses were estimated using dispersion modelling.
A total of 753 participants with SARS-CoV-2 infection were included of whom 116 (15.4%) reported having long COVID. The most common symptoms were altered smell/taste (n = 80, 10.6%), dyspnea (n = 36, 4.8%) and fatigue (n = 34, 4.5%). Median annual PM2.5 exposure in 2019 (pre-pandemic) was 6.39 (interquartile range [IQR] 6.06–6.71) μg/m3. Adjusted Odds Ratios (95% confidence intervals) of PM2.5 per IQR increase were 1.28 (1.02–1.60) for long COVID, 1.65 (1.09–2.50) for dyspnea symptoms and 1.29 (0.97–1.70) for altered smell/taste. Positive associations were found for the other air pollutants and remained consistent across sensitivity analyses. Associations tended to be stronger among participants with asthma, and those having had COVID during 2020 (versus 2021).
Ambient long-term PM2.5 exposure may affect the risk of long COVID in young adults, supporting efforts for continuously improving air quality.
The study received funding from the Swedish Research Council (grant no. 2020-01886, 2022-06340), the Swedish Research Council for Health, Working life and Welfare (FORTE grant no. 2017-01146), the Swedish Heart-Lung Foundation, Karolinska Institute (no. 2022-01807) and Region Stockholm (ALF project for cohort and database maintenance).</description><subject>Air pollution</subject><subject>Long COVID</subject><subject>PM2.5</subject><subject>Young adults</subject><issn>2666-7762</issn><issn>2666-7762</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>D8T</sourceid><recordid>eNp9Uc1u1DAQjhAVrdq-AUI-csliO4ljc0CqtvxUqtRDgavl2JPWWycOdrJlT7wKz8KT4Sjb0l642KP5fsaeL8teE7wimLB3m5VTPQywopgWqYUZ5i-yI8oYy-ua0ZdP6sPsNMYNxphWpKCkfJUdFjUpCGf0KPt11jUW-hEpG9DgnZtG63sEPwcfpwDI2f4ODBo9cr6_Qeur7xfnSHVzvfNTOpWZ3BjfI4V6iGOiJtkWdsj2qTX4YXJqdswbFROo_a0PYwL__L6-BwP9SXbQKhfhdH8fZ98-ffy6_pJfXn2-WJ9d5rrCZMxBlJqD5hxaXpjCYNXguqkNFrQpBGGqbQ2n1CiuMZQaGk1Y1VSEi5prLkhxnOWLb7yHYWrkEGynwk56ZeW-dZcqkGXJSD3zPyz8hHRgdFpRUO6Z7DnS21t547dSCC6YYMng7d4g-B9TWo3sbNTg5tz8FCXlWKTYKjJTy4Wqg48xQPs4hmA5xy03colbznHLJe4ke_P0iY-ih3D__QHSYrcWgow6Za3B2AB6lMbb_0_4C83ewbY</recordid><startdate>20230501</startdate><enddate>20230501</enddate><creator>Yu, Zhebin</creator><creator>Ekström, Sandra</creator><creator>Bellander, Tom</creator><creator>Ljungman, Petter</creator><creator>Pershagen, Göran</creator><creator>Eneroth, Kristina</creator><creator>Kull, Inger</creator><creator>Bergström, Anna</creator><creator>Georgelis, Antonios</creator><creator>Stafoggia, Massimo</creator><creator>Gruzieva, Olena</creator><creator>Melén, Erik</creator><creator>Almqvist, Catarina</creator><creator>Andersson, Niklas</creator><creator>Ballardini, Natalia</creator><creator>Bergström, Anna</creator><creator>Björkander, Sophia</creator><creator>Brodin, Petter</creator><creator>Castel, Anna</creator><creator>Ekström, Sandra</creator><creator>Georgelis, Antonios</creator><creator>Hammarström, Lennart</creator><creator>Pan-Hammarström, Qiang</creator><creator>Hallberg, Jenny</creator><creator>Jansson, Christer</creator><creator>Kere, Maura</creator><creator>Kull, Inger</creator><creator>Lauber, André</creator><creator>Lövquist, Alexandra</creator><creator>Melén, Erik</creator><creator>Mjösberg, Jenny</creator><creator>Mogensen, Ida</creator><creator>Palmberg, Lena</creator><creator>Pershagen, Göran</creator><creator>Roxhed, Niclas</creator><creator>Schwenk, Jochen</creator><general>Elsevier Ltd</general><general>The Author(s). Published by Elsevier Ltd</general><scope>6I.</scope><scope>AAFTH</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><scope>ADTPV</scope><scope>AOWAS</scope><scope>D8T</scope><scope>ZZAVC</scope><orcidid>https://orcid.org/0000-0001-9392-5624</orcidid><orcidid>https://orcid.org/0000-0002-0657-1512</orcidid></search><sort><creationdate>20230501</creationdate><title>Ambient air pollution exposure linked to long COVID among young adults: a nested survey in a population-based cohort in Sweden</title><author>Yu, Zhebin ; Ekström, Sandra ; Bellander, Tom ; Ljungman, Petter ; Pershagen, Göran ; Eneroth, Kristina ; Kull, Inger ; Bergström, Anna ; Georgelis, Antonios ; Stafoggia, Massimo ; Gruzieva, Olena ; Melén, Erik ; Almqvist, Catarina ; Andersson, Niklas ; Ballardini, Natalia ; Bergström, Anna ; Björkander, Sophia ; Brodin, Petter ; Castel, Anna ; Ekström, Sandra ; Georgelis, Antonios ; Hammarström, Lennart ; Pan-Hammarström, Qiang ; Hallberg, Jenny ; Jansson, Christer ; Kere, Maura ; Kull, Inger ; Lauber, André ; Lövquist, Alexandra ; Melén, Erik ; Mjösberg, Jenny ; Mogensen, Ida ; Palmberg, Lena ; Pershagen, Göran ; Roxhed, Niclas ; Schwenk, Jochen</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c501t-e94c8ec88ef83d3d0ab07b7d092b3916affd822da8c0e4cebc165b518978c8913</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Air pollution</topic><topic>Long COVID</topic><topic>PM2.5</topic><topic>Young adults</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Yu, Zhebin</creatorcontrib><creatorcontrib>Ekström, Sandra</creatorcontrib><creatorcontrib>Bellander, Tom</creatorcontrib><creatorcontrib>Ljungman, Petter</creatorcontrib><creatorcontrib>Pershagen, Göran</creatorcontrib><creatorcontrib>Eneroth, Kristina</creatorcontrib><creatorcontrib>Kull, Inger</creatorcontrib><creatorcontrib>Bergström, Anna</creatorcontrib><creatorcontrib>Georgelis, Antonios</creatorcontrib><creatorcontrib>Stafoggia, Massimo</creatorcontrib><creatorcontrib>Gruzieva, Olena</creatorcontrib><creatorcontrib>Melén, Erik</creatorcontrib><creatorcontrib>Almqvist, Catarina</creatorcontrib><creatorcontrib>Andersson, Niklas</creatorcontrib><creatorcontrib>Ballardini, Natalia</creatorcontrib><creatorcontrib>Bergström, Anna</creatorcontrib><creatorcontrib>Björkander, Sophia</creatorcontrib><creatorcontrib>Brodin, Petter</creatorcontrib><creatorcontrib>Castel, Anna</creatorcontrib><creatorcontrib>Ekström, Sandra</creatorcontrib><creatorcontrib>Georgelis, Antonios</creatorcontrib><creatorcontrib>Hammarström, Lennart</creatorcontrib><creatorcontrib>Pan-Hammarström, Qiang</creatorcontrib><creatorcontrib>Hallberg, Jenny</creatorcontrib><creatorcontrib>Jansson, Christer</creatorcontrib><creatorcontrib>Kere, Maura</creatorcontrib><creatorcontrib>Kull, Inger</creatorcontrib><creatorcontrib>Lauber, André</creatorcontrib><creatorcontrib>Lövquist, Alexandra</creatorcontrib><creatorcontrib>Melén, Erik</creatorcontrib><creatorcontrib>Mjösberg, Jenny</creatorcontrib><creatorcontrib>Mogensen, Ida</creatorcontrib><creatorcontrib>Palmberg, Lena</creatorcontrib><creatorcontrib>Pershagen, Göran</creatorcontrib><creatorcontrib>Roxhed, Niclas</creatorcontrib><creatorcontrib>Schwenk, Jochen</creatorcontrib><creatorcontrib>the BAMSE COVID-19 Study Group</creatorcontrib><creatorcontrib>BAMSE COVID-19 Study Group</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>SwePub</collection><collection>SwePub Articles</collection><collection>SWEPUB Freely available online</collection><collection>SwePub Articles full text</collection><jtitle>The Lancet regional health. 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Europe</jtitle><addtitle>Lancet Reg Health Eur</addtitle><date>2023-05-01</date><risdate>2023</risdate><volume>28</volume><spage>100608</spage><epage>100608</epage><pages>100608-100608</pages><artnum>100608</artnum><issn>2666-7762</issn><eissn>2666-7762</eissn><abstract>Post COVID-19 conditions, also known as long COVID, are of public health concern, but little is known about their underlying risk factors. We aimed to investigate associations of air pollution exposure with long COVID among Swedish young adults.
We used data from the BAMSE (Children, Allergy, Environment, Stockholm, Epidemiology [in Swedish]) cohort. From October 2021 to February 2022 participants answered a web-questionnaire focusing on persistent symptoms following acute SARS-CoV-2 infection. Long COVID was defined as symptoms after confirmed infection with SARS-CoV-2 lasting for two months or longer. Ambient air pollution levels (particulate matter ≤2.5 μm [PM2.5], ≤10 μm [PM10], black carbon [BC] and nitrogen oxides [NOx]) at individual-level addresses were estimated using dispersion modelling.
A total of 753 participants with SARS-CoV-2 infection were included of whom 116 (15.4%) reported having long COVID. The most common symptoms were altered smell/taste (n = 80, 10.6%), dyspnea (n = 36, 4.8%) and fatigue (n = 34, 4.5%). Median annual PM2.5 exposure in 2019 (pre-pandemic) was 6.39 (interquartile range [IQR] 6.06–6.71) μg/m3. Adjusted Odds Ratios (95% confidence intervals) of PM2.5 per IQR increase were 1.28 (1.02–1.60) for long COVID, 1.65 (1.09–2.50) for dyspnea symptoms and 1.29 (0.97–1.70) for altered smell/taste. Positive associations were found for the other air pollutants and remained consistent across sensitivity analyses. Associations tended to be stronger among participants with asthma, and those having had COVID during 2020 (versus 2021).
Ambient long-term PM2.5 exposure may affect the risk of long COVID in young adults, supporting efforts for continuously improving air quality.
The study received funding from the Swedish Research Council (grant no. 2020-01886, 2022-06340), the Swedish Research Council for Health, Working life and Welfare (FORTE grant no. 2017-01146), the Swedish Heart-Lung Foundation, Karolinska Institute (no. 2022-01807) and Region Stockholm (ALF project for cohort and database maintenance).</abstract><cop>England</cop><pub>Elsevier Ltd</pub><pmid>37131862</pmid><doi>10.1016/j.lanepe.2023.100608</doi><tpages>1</tpages><orcidid>https://orcid.org/0000-0001-9392-5624</orcidid><orcidid>https://orcid.org/0000-0002-0657-1512</orcidid><oa>free_for_read</oa></addata></record> |
fulltext | fulltext |
identifier | ISSN: 2666-7762 |
ispartof | The Lancet regional health. Europe, 2023-05, Vol.28, p.100608-100608, Article 100608 |
issn | 2666-7762 2666-7762 |
language | eng |
recordid | cdi_swepub_primary_oai_swepub_ki_se_446171 |
source | DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central; Alma/SFX Local Collection; SWEPUB Freely available online |
subjects | Air pollution Long COVID PM2.5 Young adults |
title | Ambient air pollution exposure linked to long COVID among young adults: a nested survey in a population-based cohort in Sweden |
url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-05T21%3A07%3A20IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_swepu&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Ambient%20air%20pollution%20exposure%20linked%20to%20long%20COVID%20among%20young%20adults:%20a%20nested%20survey%20in%20a%20population-based%20cohort%20in%C2%A0Sweden&rft.jtitle=The%20Lancet%20regional%20health.%20Europe&rft.au=Yu,%20Zhebin&rft.aucorp=the%20BAMSE%20COVID-19%20Study%20Group&rft.date=2023-05-01&rft.volume=28&rft.spage=100608&rft.epage=100608&rft.pages=100608-100608&rft.artnum=100608&rft.issn=2666-7762&rft.eissn=2666-7762&rft_id=info:doi/10.1016/j.lanepe.2023.100608&rft_dat=%3Cproquest_swepu%3E2809006516%3C/proquest_swepu%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2809006516&rft_id=info:pmid/37131862&rft_els_id=S2666776223000261&rfr_iscdi=true |