Air pollution exposure, cause-specific deaths and hospitalizations in a highly polluted Italian region

Impact of short-term exposure to air pollution on natural mortality and vulnerable populations: a multi-city case-crossover analysis in Belgium

BACKGROUND

The adverse effect of air pollution on mortality is well documented worldwide but the identification of more vulnerable populations at higher risk of death is still limited. The aim of this study was to evaluate the association between natural mortality (overall and cause-specific) and short-term exposure to five air pollutants (PM2.5, PM10, NO2, O3 and black carbon) and identify potential vulnerable populations in Belgium.

METHODS

We used a time-stratified case-crossover design with conditional logistic regressions to assess the relationship between mortality and air pollution in the nine largest Belgian agglomerations. Then, we performed a random-effect meta-analysis of the pooled results and described the global air pollution-mortality association. We carried out stratified analyses by individual characteristics (sex, age, employment, hospitalization days and chronic preexisting health conditions), living environment (levels of population density, built-up areas) and season of death to identify effect modifiers of the association.

RESULTS

The study included 304,754 natural deaths registered between 2010 and 2015. We found percentage increases for overall natural mortality associated with 10 μg/m3 increases of air pollution levels of 0.6% (95% CI: 0.2%, 1.0%) for PM2.5, 0.4% (0.1%, 0.8%) for PM10, 0.5% (-0.2%, 1.1%) for O3, 1.0% (0.3%, 1.7%) for NO2 and 7.1% (-0.1%, 14.8%) for black carbon. There was also evidence for increases of cardiovascular and respiratory mortality. We did not find effect modification by individual characteristics (sex, age, employment, hospitalization days). However, this study suggested differences in risk of death for people with preexisting conditions (thrombosis, cardiovascular diseases, asthma, diabetes and thyroid affections), season of death (May-September vs October-April) and levels of built-up area in the neighborhood (for NO2).

CONCLUSIONS

This work provided evidence for the adverse health effects of air pollution and contributed to the identification of specific population groups. These findings can help to better define public-health interventions and prevention strategies.

Potential causal links of long-term air pollution with lung cancer incidence: From the perspectives of mortality and hospital admission in a large cohort study in southern China

Evidence on the potential causal links of long-term air pollution exposure with lung cancer incidence (reflected by mortality and hospital admission) was limited, especially based on large cohorts. We examined the relationship between lung cancer and long-term exposure to particulate matter (PM, including PM2.5 , PM10 and PM10-2.5 ) and nitrogen dioxide (NO2 ) among a large cohort of general Chinese adults using causal inference approaches. The study included 575 592 participants who were followed up for an average of 8.2 years. The yearly exposure of PM and NO2 was estimated through satellite-based random forest approaches and the ordinary kriging method, respectively. Marginal structural Cox models were used to examine hazard ratios (HRs) of mortality and hospital admission due to lung cancer following air pollution exposure, adjusting for potential confounders. The HRs of mortality due to lung cancer were 1.042 (95% confidence interval [CI]: 1.033-1.052), 1.032 (95% CI:1.024-1.041) and 1.052 (95% CI:1.041-1.063) for each 1 μg/m3 increase in PM2.5 , PM10 and NO2 , respectively. In addition, we observed statistically significant effects of PMs on hospital admission due to lung cancer. The HRs (95%CI) were 1.110 (1.027-1.201), 1.067 (1.020-1.115) and 1.079 (1.010-1.153) for every 1 μg/m3 increase in PM2.5 , PM10 , PM10-2.5 , respectively. Furthermore, we found larger effect estimates among the elderly and those who exercised more frequently. We provided the most comprehensive evidence of the potential causal links between two outcomes of lung cancer and long-term air pollution exposure. Relevant policies should be developed, with special attention to protecting the vulnerable groups of the population.

The association of long-term exposure to outdoor air pollution with all-cause GP visits and hospital admissions by ethnicity and country of birth in the United Kingdom

BACKGROUND

Air pollution is associated with poor health. Yet, more research is needed to reveal the association of long-term exposure to outdoor air pollution with less studied health outcomes like hospital admissions and general-practitioner (GP) visits and whether this association is stronger for ethnic minorities compared to the rest of population. This study investigates the association between air pollution and all-cause GP visits and hospital admissions by ethnicity in the United-Kingdom (UK).

METHODS

We used individual-level longitudinal data from the "UK Household Longitudinal Study" including 46,442 adult individuals who provided 140,466 responses across five years (2015-2019). This data was linked to yearly concentrations of NO2, SO2, and particulate-matter (PM10, PM2.5) outdoor pollution using the Lower Super Output Area (LSOA) of residence for each individual. Multilevel mixed-effects ordered logistic models were used to assess the association between air pollution and all-cause GP visits and hospital admissions.

RESULTS

We found higher odds of hospital admissions per 1 μg/m3 increase in annual concentrations of NO2 (OR = 1.008; 95%CI = 1.004-1.012), SO2 (OR = 1.048; 95%CI = 1.014-1.083), PM10 (OR = 1.011; 95%CI = 1.003-1.018), and PM2.5 (OR = 1.018; 95%CI = 1.007-1.029) pollutants. Higher odds of GP visits were also observed with increased exposure to NO2 (OR = 1.010; 95%CI = 1.006-1.014) and SO2 (OR = 1.114; 95%CI = 1.077-1.152) pollutants. The observed associations did not differ across ethnic groups, but by country of birth, they were more pronounced in individuals born outside UK than those born in UK.

CONCLUSION

This study supports an association between higher exposure to outdoor air pollution and increased all-cause hospital admissions and GP visits. Further longitudinal studies with longer follow-up time periods may be able to reveal more definite conclusions on the influence of ethnicity on the association between long-term outdoor air pollution and both hospital admissions and GP visits.

Association Between the Combined Effects of Physical Activity Intensity and Particulate Matter and All-Cause Mortality in Older Adults

OBJECTIVE

To investigate the association between the combined effects of physical activity (PA) intensity and particulate matter ≤10 μm in diameter (PM10) and mortality in older adults.

METHODS

This nationwide cohort study included older adults without chronic heart or lung disease who engaged in regular PA. Physical activity was assessed by a standardized, self-reported questionnaire that asked the usual frequency of PA sessions with low (LPA), moderate (MPA), or vigorous intensity (VPA). Each participant's annual average cumulative PM10 was categorized as low to moderate and high PM10 on the basis of a cutoff value of 90th percentile.

RESULTS

A total of 81,326 participants (median follow-up, 45 months) were included. For participants engaged in MPA or VPA sessions, every 10% increase in the proportion of VPA to total PA sessions resulted in a 4.9% (95% CI, 1.0% to 9.0%; P=.014) increased and 2.8% (95% CI, -5.0% to -0.5%; P=.018) decreased risk of mortality for those exposed to high and low to moderate PM10, respectively (Pinteraction, <.001). For participants engaged only in LPA or MPA sessions, every 10% increase in the proportion of MPA to total PA sessions resulted in a 4.8% (95% CI, -8.9% to -0.4%; P=.031) and 2.3% (95% CI, -4.2% to -0.3%; P=.023) decreased risk of mortality for those exposed to high and low to moderate PM10, respectively (Pinteraction, .096).

CONCLUSION

We found that for the same level of total PA, MPA was associated with delayed mortality whereas VPA was associated with hastened mortality of older adults in high levels of PM10.

Long-term exposure and health risk assessment from air pollution: impact of regional scale mobility

BACKGROUND

The negative effect of air pollution on human health is widely reported in recent literature. It typically involves urbanized areas where the population is concentrated and where most primary air pollutants are produced. A comprehensive health risk assessment is therefore of strategic importance for health authorities.

METHODS

In this study we propose a methodology to perform an indirect and retrospective health risk assessment of all-cause mortality associated with long-term exposure to particulate matter less than 2.5 microns (PM2.5), nitrogen dioxide (NO2) and ozone (O3) in a typical Monday to Friday working week. A combination of satellite-based settlement data, model-based air pollution data, land use, demographics and regional scale mobility, allowed to examine the effect of population mobility and pollutants daily variations on the health risk. A Health Risk Increase (HRI) metric was derived on the basis of three components: hazard, exposure and vulnerability, utilizing the relative risk values from the World Health Organization. An additional metric, the Health Burden (HB) was formulated, which accounts for the total number of people exposed to a certain risk level.

RESULTS

The effect of regional mobility patterns on the HRI metric was assessed, resulting in an increased HRI associated with all three stressors when considering a dynamic population compared to a static one. The effect of diurnal variation of pollutants was only observed for NO2 and O3. For both, the HRI metric resulted in significantly higher values during night. Concerning the HB parameter, we identified the commuting flows of the population as the main driver in the resulting metric.

CONCLUSIONS

This indirect exposure assessment methodology provides tools to support policy makers and health authorities in planning intervention and mitigation measures. The study was carried out in Lombardy, Italy, one of the most polluted regions in Europe, but the incorporation of satellite data makes our approach valuable for studying global health.

The spatial-temporal effect of air pollution on individuals' reported health and its variation by ethnic groups in the United Kingdom: a multilevel longitudinal analysis

BACKGROUND

Air pollution is associated with poor health; though it is unclear whether this association is stronger for ethnic minorities compared to the rest of the population. This study uses longitudinal data to investigate the spatial-temporal effect of air pollution on individuals' reported health and its variation by ethnicity in the United-Kingdom (UK).

METHODS

Longitudinal individual-level data from Understanding Society: the UK Household Longitudinal Study including 67,982 adult individuals with 404,264 repeated responses over 11 years (2009-2019) were utilized and were linked to yearly concentrations of NO₂, SO₂, and particulate-matter (PM10, PM2.5) pollution once at the local authority and once at the census Lower Super Output Area (LSOA) of residence for each individual. This allows for analysis at two geographical scales over time. The association between air pollution and individuals' health (Likert scale: 1-5, Excellent to poor) and its variation by ethnicity was assessed using three-level mixed-effects ordered logistic models. Analysis distinguished between spatial (between areas) and temporal (across time within each area) effects of air pollution on health.

RESULTS

Higher concentrations of NO₂, SO₂, PM10, and PM2.5 pollution were associated with poorer health. Decomposing air pollution into between (spatial: across local authorities or LSOAs) and within (temporal: across years within each local authority or LSOA) effects showed a significant between effect for NO₂ and SO₂ pollutants at both geographical scales, while a significant between effect for PM10 and PM2.5 was shown only at the LSOAs level. No significant within effects were detected at an either geographical level. Indian, Pakistani/Bangladeshi, Black/African/Caribbean and other ethnic groups and non-UK-born individuals reported poorer health with increasing concentrations of NO₂, SO₂, PM10, and PM2.5 pollutants in comparison to the British-white and UK-born individuals.

CONCLUSION

Using longitudinal data on individuals' health linked with air pollution data at two geographical scales (local authorities and LSOAs), this study supports the presence of a spatial-temporal association between air pollution and poor self-reported health, which is stronger for ethnic minorities and foreign-born individuals in the UK, partly explained by location-specific differences. Air pollution mitigation is necessary to improve individuals' health, especially for ethnic minorities who are affected the most.

Short-term air pollution exposure and hospital admissions for cardiorespiratory diseases in Brazil: A nationwide time-series study between 2008 and 2018

The established evidence associating air pollution with health is limited to populations from specific regions. Further large-scale studies in several regions worldwide are needed to support the literature to date and encourage national governments to act. Brazil is an example of these regions where little research has been performed on a large scale. To address this gap, we conducted a study looking at the relationship between daily PM_2.5, NO₂, and O₃, and hospital admissions for circulatory and respiratory diseases across Brazil between 2008 and 2018. A time-series analytic approach was applied with a distributed lag modeling framework. We used a generalized conditional quasi-Poisson regression model to estimate relative risks (RRs) of the association of each air pollutant with the hospitalization for circulatory and respiratory diseases by sex, age group, and Brazilian regions. Our study population includes 23, 791, 093 hospital admissions for cardiorespiratory diseases in Brazil between 2008 and 2018. Among those, 53.1% are respiratory diseases, and 46.9% are circulatory diseases. Our findings suggest significant associations of ambient air pollution (PM_2.5, NO₂, and O₃) with respiratory and circulatory hospital admissions in Brazil. The national meta-analysis for the whole population showed that for every increase of PM_2.5 by 10 μg/m³, there is a 3.28% (95%CI: 2.61; 3.94) increase in the risk of hospital admission for respiratory diseases. For O₃, we found positive associations only for some sub-group analyses by age and sex. For NO₂, our findings suggest that a 10 ppb increase in this pollutant, there was a 35.26% (95%CI: 24.07; 46.44) increase in the risk of hospital admission for respiratory diseases. This study may better support policymakers to improve the air quality and public health in Brazil.

Association between air pollution exposure and coronary heart disease hospitalization in a humid sub-tropical region of China: A time-series study

Objective

Emerging evidence has highlighted the possible links of environmental pollution with several cardiovascular diseases (CVDs). The current study aimed to explore the impact of short-term air pollution exposure on CHD hospitalization in Hefei.

Methods

Data about the daily number of CHD admissions (from 2014 to 2021) were retrieved from the First Affiliated Hospital of Anhui Medical University. Air pollutants and meteorological data were obtained from the China Environmental Monitoring Station and the China Meteorological Data Service Center, respectively. The correlation between air pollution and CHD hospitalization was assessed using distributed lag non-linear model (DLNM) and Poisson generalized linear regression.

Results

In the single-pollutant model, NO₂, O₃, and CO strongly correlated with CHD hospitalization rate. Specifically, exposure to NO₂ (lag0, relative risk [RR]: 1.013, 95%CI: 1.002-1.024, per 10 μg/m³ increase) and CO (lag13, RR: 1.035, 95%CI: 1.001-1.071, per 1 μg/m³ increase) revealed a positive correlation with an increased rate of CHD hospitalization. Interestingly, O₃ had a protective association with hospitalization of CHD (lag0, RR: 0.993, 95%CI: 0.988-0.999, per 10 μg/m³ increase). Similar results, to those of the single-pollutant model, were revealed following verification using two-pollutant models. Subgroup analyses indicated that young people, women, and people in hot seasons were more susceptible to NO₂ exposure, while the elderly, women, and people in cold seasons were more susceptible to O₃. Furthermore, the elderly were more susceptible to CO exposure.

Conclusion

Overall, exposure to NO₂ and CO increases the rate of CHD hospitalization, but exposure to O₃ shows a protective association with the rate of CHD hospitalization. Therefore, early preventive measures against air pollutants should be applied to protect vulnerable patients with CHD.

Association between short-term exposure to air pollutants and cause-specific daily mortality in Italy. A nationwide analysis

BACKGROUND/AIM

Daily air pollution has been linked with mortality from urban studies. Associations in rural areas are still unclear and there is growing interest in testing the role that air pollution has on other causes of death. This study aims to evaluate the association between daily air pollution and cause-specific mortality in all 8092 Italian municipalities.

METHODS

Natural, cardiovascular, cardiac, ischemic, cerebrovascular, respiratory, metabolic, diabetes, nervous and psychiatric causes of death occurred in Italy were extracted during 2013-2015. Daily ambient PM₁₀, PM_2.5 and NO₂ concentrations were estimated through machine learning algorithms. The associations between air pollutants and cause-specific mortality were estimated with a time-series approach using a two-stage analytic protocol where area-specific over-dispersed Poisson regression models where fit in the first stage, followed by a meta-analysis in the second. We tested for effect modification by sex, age class and the degree of urbanisation of the municipality.

RESULTS

We estimated a positive association between PM₁₀ and PM_2.5 and the mortality from natural, cardiovascular, cardiac, respiratory and nervous system causes, but not with metabolic or psychiatric causes of death. In particular, mortality from nervous diseases increased by 4.55% (95% CI: 2.51-6.63) and 9.64% (95% CI: 5.76-13.65) for increments of 10 μg/m³ in PM₁₀ and PM_2.5 (lag 0-5 days), respectively. NO₂ was positively associated with respiratory (6.68% (95% CI: 1.04-12.62)) and metabolic (7.30% (95% CI: 1.03-13.95)) mortality for increments of 10 μg/m³ (lag 0-5). Higher associations with natural mortality were found among the elderly, while there were no differential effects between sex or between rural and urban areas.

CONCLUSIONS

Short-term exposure to particulate matter was associated with mortality from nervous diseases. Mortality from metabolic diseases was associated with NO₂ exposure. Other associations are confirmed and updated, including the contribution of lowly urbanised areas. Health effects were also found in suburban and rural areas.

Resistance to Critical Important Antibacterials in Staphylococcus pseudintermedius Strains of Veterinary Origin

Staphylococcal infections represent a challenge in companion animals and hospitalized patients. This study aimed to assess the resistance of Staphylococcus pseudintermedius isolates, against a broad panel of antibacterials, including exclusive to human medicine. A total of 40 S. pseudintermedius were collected from clinical specimens of dogs (n = 31) and cats (n = 5). All strains were tested for 20 antibacterials, namely 14 Critical Important and eight Highly Important Antibacterials (CIA and HIA, respectively), indicative for 18 antimicrobial classes. All strains were susceptible to seven antibiotics (daptomycin, fosfomycin, fusidic acid, linezolid, quinupristin-dalfopristin, teicoplanin/vancomycin, tigecycline). The highest resistance was against penicillin (97.5% Confidence Interval [CI]: 83.8-100.0), whereas the lowest against telavancin (2.5%, CI: 0.0-16.2). Resistance versus Highest Priority CIA was observed, namely against macrolides (70.0, CI: 52.1-84.3), quinolones (62.5, CI: 44.5-78.3), 5th generation cephalosporins (7.5, CI: 1.3-21.6), and glycopeptides (2.5%, CI: 0.0-14.2). Among High Priority CIA, strains were resistant only to aminoglycosides (65.0, CI: 47.0-80.4) and ansamycins (12.5, CI: 3.8-28.1). We observed the highest resistance against veterinary medicine antibacterials, but there was also resistance against antibacterials exclusive to human medicine, namely ceftaroline (7.5, CI: 1.0-23.8) and telavancin. S. pseudintermedius zoonotic potential and its rate of acquisition of new resistance should encourage surveillance on a broad spectrum of antibacterials.

Association between Air Pollution and Squamous Cell Lung Cancer in South-Eastern Poland

Air pollution is closely associated with the development of respiratory illness. The aim of the present study was to assess the relationship between long-term exposure to PM2.5, PM10, NO₂, and SO₂ pollution and the incidence of lung cancer in the squamous subtype in south-eastern Poland from the years 2004 to 2014. We collected data of 4237 patients with squamous cell lung cancer and the level of selected pollutants. To investigate the relationship between the level of concentrations of pollutants and the place of residence of patients with lung cancer in the squamous subtype, proprietary pollution maps were applied to the places of residence of patients. To analyze the data, the risk ratio was used as well as a number of statistical methods, i.e., the pollution model, inverse distance weighted interpolation, PCA, and ordered response model. Cancer in women and in men seems to depend in particular on the simultaneous inhalation of NO₂ and PM10 (variable NO₂PM10) and of NO₂ and SO₂ (variable NO₂ SO₂), respectively. Nitrogen dioxide exercises a synergistic leading effect, which once composed with the other elements it becomes more persistent in explaining higher odds in the appearance of cancers and could constitute the main cause of squamous cancer.

First satellite-based regional hourly NO2 estimations using a space-time ensemble learning model: A case study for Beijing-Tianjin-Hebei Region, China

Surface Nitrogen dioxide (NO₂) concentrations have been generated with satellite retrievals using multiple statistical algorithms. However, they are often given at coarse frequencies ("snapshot", daily or even longer), limiting their applications in epidemiological studies and assessing the evolution of NO₂ pollution. This study investigated the potential applicability of Himawari-8 derived hourly fine particulate matter concentrations in producing hourly NO₂ concentrations by constructing a space-time ensemble model. The Beijing-Tianjin-Hebei (BTH) region, one of the serious pollution regions in China, is the study region chosen. The proposed model performs well in estimating hourly NO₂ concentration with a high cross-validation (CV) coefficient of determination (R² = 0.81) and low CV root-mean-square (RMSE = 9.71 μg/m³), mean prediction errors (MPE = 6.33 μg/m³), and relative prediction errors (RPE = 22.5%). On daily, monthly, seasonal, and annual time scales, CV R² increases to 0.89, 0.93, 0.97, and 0.99, respectively. The annual mean model estimated NO₂ concentration over BTH region is 28.2 ± 6.5 μg/m³, with relatively higher NO₂ concentrations are seen in southern and southeastern BTH. Winter experiences the most severe NO₂ concentrations, followed by autumn, spring, and summer. Surface NO₂ concentrations are higher (lower) in the morning (afternoon) and tend to decrease gradually with time. The model generally captures the hourly evolution of NO₂ concentrations for the severe pollution episode but shows some underestimations. The annual mean NO₂ concentrations were 2.8% lower on the weekend than on weekdays. In addition, the weekend effects of NO₂ concentrations are larger at rush hour and lower in the noon. The hourly NO₂ products derived from proposed approach are potentially useful for improving our understanding of the source, evolution, and transportation behavior of NO₂ pollution episodes and for exposure- and health-related research. The proposed approach also enriches the potential applications of geostationary satellites (e.g., Himawari-8).

Long-Term Exposure to Fine Particulate Matter and the Deterioration of Estimated Glomerular Filtration Rate: A Cohort Study in Patients With Pre-End-Stage Renal Disease

Limited literature has explored the effect of air pollutants on chronic kidney disease (CKD) progression, especially for patients with pre-end-stage renal disease (pre-ESRD). In this study, we reported the linear and nonlinear relationships of air pollutants of particles with diameter <2.5 μm (PM2.5) and nitrogen dioxide (NO2) with estimated glomerular filtration rate (eGFR) deterioration after adjusting for smoking status and other traditional clinical factors. This study adopted a retrospective cohort of patients with stage 3b to stage 5 CKD (N = 11,479) from Taichung Veterans General Hospital during January 2006 to December 2020. The eGFR deterioration was defined as a decline in eGFR > 5 ml/min/1.73 m2/year. Hybrid kriging/land-use regression models were used to estimate the individual exposure levels of PM2.5 and NO2. The relationships of air pollutants with eGFR deterioration were evaluated using Cox proportional hazard models. After adjusting for smoking status, baseline eGFR stages, and other traditional clinical factors, the risk of eGFR deterioration was found to increase with increasing PM2.5 and NO2 level (p < 0.0001 and p = 0.041, respectively), especially for those exposed to PM2.5 ≥ 31.44 μg/m3 or NO2 ≥ 15.00 ppb. Similar results were also found in the two-pollutant models. Nonlinear dose-response relationships of eGFR deterioration were observed for concentrations of 26.11 μg/m3 for PM2.5 and 15.06 ppb for NO2. In conclusion, linear and nonlinear associations between PM2.5 and NO2 levels and the incidence risk of eGFR deterioration were observed in patients with pre-ESRD.

Effects of ambient air pollutants on hospital admissions and deaths for cardiovascular diseases: a time series analysis in Tehran

Short-term exposures to air pollution have been associated with various adverse health effects. In this study, we investigated the associations between ambient air pollutants with the number of hospital admissions and mortality from cardiovascular diseases (CVDs). This time series study was conducted in Tehran for the years 2014-2017 (1220 day). We collected the ambient air pollutant concentration data from the regulatory monitoring stations. The health data were obtained from the Ministry of Health and Medical Education. A distributed lag non-linear model (DLNM) was used for the analyses. Total CVDs and ischemic heart disease (IHD) admissions were associated with CO for each 1 mg/m³ increase at lags of 6 and 7 days. Also, there was a positive association between total CVDs (RR 1.01; 1.001 to 1.03), IHD (RR 1.04; 1.006 to 1.07), and cerebrovascular diseases (RR 1.03; 1.005 to 1.07) mortality with SO₂ at a lag of 4 days. PM_2.5 and PM₁₀ were associated with cerebrovascular disease admissions in females aged 16-65 years and 16 years and younger for each 10 µg/m³ increase, respectively. Short-term exposure to SO₂, NO₂, and CO was associated with hospital admissions and mortality for CVDs, IHD, cerebrovascular diseases, and other cardiovascular diseases at different lags. Moreover, females were more affected by ambient air pollutants than males in terms of their burden of CVDs. Therefore, identifying the likely harmful effects of pollutants given their current concentrations requires the planning and implementation of strategies to reduce air pollution.

A nationwide study of air pollution from particulate matter and daily hospitalizations for respiratory diseases in Italy

BACKGROUND/AIM

The relationship between air pollution and respiratory morbidity has been widely addressed in urban and metropolitan areas but little is known about the effects in non-urban settings. Our aim was to assess the short-term effects of PM10 and PM2.5 on respiratory admissions in the whole country of Italy during 2006-2015.

METHODS

We estimated daily PM concentrations at the municipality level using satellite data and spatiotemporal predictors. We collected daily counts of respiratory hospital admissions for each Italian municipality. We considered five different outcomes: all respiratory diseases, asthma, chronic obstructive pulmonary disease (COPD), lower and upper respiratory tract infections (LRTI and URTI). Meta-analysis of province-specific estimates obtained by time-series models, adjusting for temperature, humidity and other confounders, was applied to extrapolate national estimates for each outcome. At last, we tested for effect modification by sex, age, period, and urbanization score. Analyses for PM_2.5 were restricted to 2013-2015 cause the goodness of fit of exposure estimation.

RESULTS

A total of 4,154,887 respiratory admission were registered during 2006-2015, of which 29% for LRTI, 12% for COPD, 6% for URTI, and 3% for asthma. Daily mean PM₁₀ and PM_2.5 concentrations over the study period were 23.3 and 17 μg/m³, respectively. For each 10 μg/m³ increases in PM₁₀ and PM_2.5 at lag 0-5 days, we found excess risks of total respiratory diseases equal to 1.20% (95% confidence intervals, 0.92, 1.49) and 1.22% (0.76, 1.68), respectively. The effects for the specific diseases were similar, with the strongest ones for asthma and COPD. Higher effects were found in the elderly and in less urbanized areas.

CONCLUSIONS

Short-term exposure to PM is harmful for the respiratory system throughout an entire country, especially in elderly patients. Strong effects can be found also in less urbanized areas.

The short-term effects and burden of particle air pollution on hospitalization for coronary heart disease: a time-stratified case-crossover study in Sichuan, China

BACKGROUND

Coronary heart disease (CHD), the leading cause of death globally, might be developed or exacerbated by air pollution, resulting high burden to patients. To date, limited studies have estimated the relations between short-term exposure to air pollution and CHD disease burden in China, with inconsistent results. Hence, we aimed to estimate the short-term impact and burden of ambient PM pollutants on hospitalizations of CHD and specific CHD.

METHODS

PM10 and PM2.5 were measured at 82 monitoring stations in 9 cities in Sichuan Province, China during 2017-2018. Based on the time-stratified case-crossover design, the effects of short-term exposure to particle matter (PM) pollution on coronary heart disease (CHD) hospital admissions were estimated. Meanwhile, the linked burden of CHD owing to ambient PM pollution were estimated.

RESULTS

A total of 104,779 CHD records were derived from 153 hospitals from these 9 cities. There were significant effects of PM pollution on hospital admissions (HAs) for CHD and specific CHD in Sichuan Province. A 10 μg/m3 increase of PM10 and PM2.5 was linked with a 0.46% (95% CI: 0.08, 0.84%), and 0.57% (95% CI: 0.05, 1.09%) increments in HAs for CHD at lag7, respectively. The health effects of air pollutants were comparable modified by age, season and gender, showing old (≥ 65 years) and in cold season being more vulnerable to the effects of ambient air pollution, while gender-specific effects is positive but not conclusive. Involving the WHO's air quality guidelines as the reference, 1784 and 2847 total cases of HAs for CHD could be attributable to PM10 and PM2.5, separately. The total medical cost that could be attributable to exceeding PM10 and PM2.5 were 42.04 and 67.25 million CNY from 2017 to 2018, respectively.

CONCLUSIONS

This study suggested that the short-term exposure to air pollutants were associated with increased HAs for CHD in Sichuan Province, which could be implications for local environment improvement and policy reference.

Short-Term Joint Effects of PM10, NO2 and SO2 on Cardio-Respiratory Disease Hospital Admissions in Cape Town, South Africa

Background/Aim: In sub-Sahara Africa, few studies have investigated the short-term association between hospital admissions and ambient air pollution. Therefore, this study explored the association between multiple air pollutants and hospital admissions in Cape Town, South Africa. Methods: Generalized additive quasi-Poisson models were used within a distributed lag linear modelling framework to estimate the cumulative effects of PM₁₀, NO₂, and SO₂ up to a lag of 21 days. We further conducted multi-pollutant models and stratified our analysis by age group, sex, and season. Results: The overall relative risk (95% confidence interval (CI)) for PM₁₀, NO₂, and SO₂ at lag 0–1 for hospital admissions due to respiratory disease (RD) were 1.9% (0.5–3.2%), 2.3% (0.6–4%), and 1.1% (−0.2–2.4%), respectively. For cardiovascular disease (CVD), these values were 2.1% (0.6–3.5%), 1% (−0.8–2.8%), and −0.3% (−1.6–1.1%), respectively, per inter-quartile range increase of 12 µg/m³ for PM₁₀, 7.3 µg/m³ for NO₂, and 3.6 µg/m³ for SO₂. The overall cumulative risks for RD per IQR increase in PM₁₀ and NO₂ for children were 2% (0.2–3.9%) and 3.1% (0.7–5.6%), respectively. Conclusion: We found robust associations of daily respiratory disease hospital admissions with daily PM₁₀ and NO₂ concentrations. Associations were strongest among children and warm season for RD.

Geospatial Correlation Analysis between Air Pollution Indicators and Estimated Speed of COVID-19 Diffusion in the Lombardy Region (Italy)

Background: the Lombardy region in Italy was the first area in Europe to record an outbreak of COVID-19 and one of the most affected worldwide. As this territory is strongly polluted, it was hypothesized that pollution had a role in facilitating the diffusion of the epidemic, but results are uncertain. Aim: the paper explores the effect of air pollutants in the first spread of COVID-19 in Lombardy, with a novel geomatics approach addressing the possible confounding factors, the reliability of data, the measurement of diffusion speed, and the biasing effect of the lockdown measures. Methods and results: all municipalities were assigned to one of five possible territorial classes (TC) according to land-use and socio-economic status, and they were grouped into districts of 100,000 residents. For each district, the speed of COVID-19 diffusion was estimated from the ambulance dispatches and related to indicators of mean concentration of air pollutants over 1, 6, and 12 months, grouping districts in the same TC. Significant exponential correlations were found for ammonia (NH₃) in both prevalently agricultural (R² = 0.565) and mildly urbanized (R² = 0.688) areas. Conclusions: this is the first study relating COVID-19 estimated speed of diffusion with indicators of exposure to NH₃. As NH₃ could induce oxidative stress, its role in creating a pre-existing fragility that could have facilitated SARS-CoV-2 replication and worsening of patient conditions could be speculated.

Short-term exposure to nitrogen dioxide and mortality: A systematic review and meta-analysis

BACKGROUND

Ambient air pollution has been characterized as a leading cause of mortality worldwide and has been associated with cardiovascular and respiratory diseases. There is increasing evidence that short-term exposure to nitrogen dioxide (NO₂), is related to adverse health effects and mortality.

METHODS

We conducted a systematic review of short-term NO₂ and daily mortality, which were indexed in PubMed and Embase up to June 2021. We calculated random-effects estimates by different continents and globally, and tested for heterogeneity and publication bias.

RESULTS

We included 87 articles in our quantitative analysis. NO₂ and all-cause as well as cause-specific mortality were positively associated in the main analysis. For all-cause mortality, a 10 ppb increase in NO₂ was associated with a 1.58% (95%CI 1.28%-1.88%, I² = 96.3%, Eggers' test p < 0.01, N = 57) increase in the risk of death. For cause-specific mortality, a 10 ppb increase in NO₂ was associated with a 1.72% (95%CI 1.41%-2.04%, I² = 87.4%, Eggers' test p < 0.01, N = 42) increase in cardiovascular mortality and a 2.05% (95%CI 1.52%-2.59%, I² = 78.5%, Eggers' test p < 0.01, N = 38) increase in respiratory mortality. In the sensitivity analysis, the meta-estimates for all-cause mortality, cardiovascular and respiratory mortality were nearly identical. The heterogeneity would decline to varying degrees through regional and study-design stratification.

CONCLUSIONS

This study provides evidence of an association between short-term exposure to NO₂, a proxy for traffic-sourced air pollutants, and all-cause, cardiovascular and respiratory mortality.

Associations Between Air Pollution Exposure and Daily Pediatric Outpatient Visits for Dry Eye Disease: A Time-Series Study in Shenzhen, China

Objectives: This study aimed to investigate the associations between air pollution exposure and pediatric outpatient visits for dry eye disease (DED) in Shenzhen, China.

Methods: Generalized additive models were utilized to explore the acute effects of air pollution exposure on pediatric outpatient visits for DED.

Results: Single-day lag exposures to NO₂, O₃, PM_2.5, and PM₁₀ were associated with DED outpatient visits at lag days 0, 6, 4 and 2. Relative risks (RRs) for DED given a 10-μg/m³ increase in NO₂, O₃, PM_2.5, and PM₁₀ concentrations were 1.062[95% confidence interval (CI) 1.003, 1.123], 1.015(95% CI 1.001, 1.031), 1.052(95% CI 1.001, 1.115), and 1.038 (95% CI 1.002, 1.076), respectively. RR for DED given a 10-μg/m³ increase in NO₂ over cumulative lag days 0–1 was 1.075 (95% CI 1.009, 1.147), and RR for DED given a 10-μg/m³ increase in PM₁₀ over cumulative lag days 0–4 was 1.051 (95% CI 1.003, 1.102).

Conclusion: The observed associations between air pollution and outpatient visits for DED may provide evidence for policy makers to consider implementing measures to reduce the risk of DED owing to air pollution in China.

Analysis of some factors related to dust storms occurrence in the Sistan region

Dust storms over the Sistan region in East Iran are associated with predominant northwest winds (called 120-day winds) which promote desertification, including drying of the Hamoun wetlands. These storms are more frequent in spring and summer seasons in the Sistan region. The study aims to examine the relationship between vegetation cover and wind speed with dust storms intensity in order to understand the behavior of dust sources using satellite remote sensing data (AOD) between 2000 and 2019. Based on the time series, the study period can be divided into three parts based on the following characteristics: high dust intensity (2004), moderate relative intensity of value in all parameters studied (2005 to 2014), and dust reduction (2015-2019). Time series analysis shows a negative relationship between AOD and wind speed owing presumably to vegetative cover changes during years that wind speed has increased. Based on multiple regression analysis by monthly time scales that conforms time series result, monthly NDVI is significantly related to AOD. Analysis of the 3 hourly wind data suggests a positive relationship between wind and dust, and effective thresholds for dust erosion based on wind speeds are proposed for the Sistan region.

Long- and Short-Term Exposures to PM10 Can Shorten Telomere Length in Individuals Affected by Overweight and Obesity

Reduced telomere length (TL) has been associated with increased risk of age-related diseases, most likely through oxidative stress and inflammation, which have also been claimed as mechanisms underlying health effects of air pollution exposure. We aimed to verify whether exposure to particulate matter with diameter ≤10 µm (PM₁₀) affects TL. We recruited 1792 participants with overweight/obesity in Milan (Italy) in 2010-2015 who completed a structured questionnaire on sociodemographic data, gave a blood sample for TL measurement by real-time PCR, and were assigned air pollution and meteorological data of their residential address. In multivariate mixed-effects linear models (with a random intercept on PCR plate), we observed a -0.51% change in TL (95% confidence interval (CI): -0.98; -0.05)) per 10 µg/m³ increase in PM₁₀ at the day of recruitment. A similar decreasing trend in TL was observed up to two weeks before withdrawal, with percentage changes as low as -1.53% (average exposure of the 12 days before recruitment). Mean annual exposure to PM₁₀ was associated with -2.57% TL reduction (95%CI: -5.06; -0.08). By showing consistent associations between short- and long-term PM₁₀ exposures and reduced TL, our findings shed light on the potential mechanisms responsible for the excess of age-related diseases associated with air pollution exposure.

Residential exposure to traffic-borne pollution as a risk factor for acute cardiocerebrovascular events: a population-based retrospective cohort study in a highly urbanized area

Background

Long-term exposure to traffic-borne noise and air pollution has been variably associated with incidence of acute vascular events, namely acute myocardial infarction, ischaemic stroke and haemorrhagic stroke. This study aims at exploring this association within a highly urbanized city.

Methods

This is a population-based retrospective dynamic cohort study including all residents aged ≥ 35 years in the municipality of Milan over the years 2011–18 (1 087 110 inhabitants). Residential exposure to road traffic noise (day-evening-night levels) and nitrogen dioxide was estimated using a noise predictive model and a land use regression model, respectively. Cox proportional hazards regression analyses were performed to assess the incidence of acute vascular events and specific outcomes in single-exposure and two-exposure models including adjustment for sociodemographic confounders, fine particulate matter and surrounding greenness.

Results

A total of 27 282 subjects (2.5%) had an acute vascular event. Models using nitrogen dioxide produced inconsistent results. The strongest effect was observed for noise, with an optimal cut-off for dichotomization set at 70 dBA (hazard ratio 1.025, 95% confidence interval 1.000–1.050). This association was observed specifically for ischaemic and haemorrhagic stroke. When stratifying by age group and sex, a remarkable effect was found for haemorrhagic stroke in men aged <60 years (hazard ratio 1.439, 95% confidence interval 1.156–1.792).

Conclusions

Living by roads with a day-evening-night noise level above 70 dBA exerts a small but tangible independent effect on the risks of both ischaemic and haemorrhagic stroke. It is urgent to propose mitigation measures against pollution and noise originating from vehicular traffic in order to reduce their impact, especially in the population younger than 60 years.

Mapping high resolution national daily NO2 exposure across mainland China using an ensemble algorithm

Nitrogen dioxide (NO₂) is an important air pollutant and highly related to air quality, short- and long-term health effects, and even climate. A national model was developed using the extreme gradient boosting algorithm with high-resolution tropospheric vertical column NO₂ densities from the Sentinel-5 Precursor/Tropospheric Monitoring Instrument and general meteorological variables as input to generate daily mean surface NO₂ concentrations across mainland China. Model-derived daily NO₂ estimates were high accuracy with sample-based cross-validation coefficient of determination of 0.83, a root-mean-square error of 7.58 μg/m³, a mean prediction error of 5.56 μg/m³, and a mean relative prediction error of 18.08%. It has good performance in NO₂ estimations at both regional and individual site scale. The model also performed well in terms of estimating monthly, seasonal, and annual mean NO₂ concentrations across China. The model performance appears to better than or comparable to most previous related studies. The seasonal and annual spatial distributions of surface NO₂ across China and several regional NO₂ hotspots in 2019 were derived from the model and analyzed. Also evaluated were the population exposure levels of NO₂ for cities in and provinces of China. At the national scale, about 12% of the population experienced annual mean NO₂ concentrations exceeding the Chinese national air quality standard. The nationwide model with conventional predictors developed here can derive high-resolution surface NO₂ concentrations across China routinely, benefitting air epidemiological and environmental related studies.

Health effects of particulate matter in major Indian cities

Background: Particulate matter (PM) is one among the crucial air pollutants and has the potential to cause a wide range of health effects. Indian cities ranked top places in the World Health Organization list of most polluted cities by PM. Objectives: Present study aims to assess the trends, short- and long-term health effects of PM in major Indian cities. Methods: PM-induced hospital admissions and mortality are quantified using AirQ+ software. Results: Annual PM concentration in most of the cities is higher than the National Ambient Air Quality Standards of India. Trend analysis showed peak PM concentration during post-monsoon and winter seasons. The respiratory and cardiovascular hospital admissions in the male (female) population are estimated to be 31,307 (28,009) and 5460 (4882) cases, respectively. PM_2.5 has accounted for a total of 1,27,014 deaths in 2017. Conclusion: Cities with high PM concentration and exposed population are more susceptible to mortality and hospital admissions.

Disruption in global supply chain and socio-economic shocks: a lesson from COVID-19 for sustainable production and consumption

The novel COVID-19 has emerged as a severe threat to global health globally, affecting over 210 countries and regions. The profound dilemma interrupted global trade and social activities and enormously influenced daily lives through social distance and confinements. The outbreak of COVID-19 has exacerbated human misery due to the crippling of economies globally. The effects are substantial on health, economy, environment, and society. Nearly every country is trying to prevent the transmission of this communicable disease. Remedial policies include testing and treating patients, isolating suspects through contact tracking, banning public gatherings, and asserting a complete or partial shutdown. In this context, the present paper's core objective is to investigate the impact of the COVID-19 pandemic on the environment and energy market, society, economy, and global protective measures taken to reduce COVID-19 transmission. The study's main contribution is revealed lessons to provide insights for business and the efficacy of governments’ initiative globally. Finally, this paper describes future actions for governments, leaders, energy providers, and all stakeholders in response to the global pandemic crisis.

Associations between mortality from COVID-19 in two Italian regions and outdoor air pollution as assessed through tropospheric nitrogen dioxide

After the appearance of COVID-19 in China last December 2019, Italy was the first European country to be severely affected by the outbreak. The first diagnosis in Italy was on February 20, 2020, followed by the establishment of a light and a tight lockdown on February 23 and on March 8, 2020, respectively. The virus spread rapidly, particularly in the North of the country in the 'Padan Plain' area, known as one of the most polluted regions in Europe. Air pollution has been recently hypothesized to enhance the clinical severity of SARS-CoV-2 infection, acting through adverse effects on immunity, induction of respiratory and other chronic disease, upregulation of viral receptor ACE-2, and possible pathogen transportation as a virus carrier. We investigated the association between air pollution and subsequent COVID-19 mortality rates within two Italian regions (Veneto and Emilia-Romagna). We estimated ground-level nitrogen dioxide through its tropospheric levels using data available from the Sentinel-5P satellites of the European Space Agency Copernicus Earth Observation Programme before the lockdown. We then examined COVID-19 mortality rates in relation to the nitrogen dioxide levels at three 14-day lag points after the lockdown, namely March 8, 22 and April 5, 2020. Using a multivariable negative binomial regression model, we found an association between nitrogen dioxide and COVID-19 mortality. Although ecological data provide only weak evidence, these findings indicate an association between air pollution levels and COVID-19 severity.

Pollutant-sex specific differences in respiratory hospitalization and mortality risk attributable to short-term exposure to ambient air pollution

BACKGROUND

Many studies have reported associations of individual pollutants with respiratory hospitalization and mortality based on different populations, which makes it difficult to directly compare adverse health effects among multiple air pollutants.

OBJECTIVES

The study goal is to compare acute respiratory-related hospitalization and mortality associated with short-term exposure to three ambient air pollutants and analyze differences in health risks by season, age and sex.

METHODS

Hourly measurements of air pollutants (ozone, NO₂, PM_2.5) and temperature were collected from ground-monitors for 24 cities along with daily hospitalization (1996-2012) and mortality (1984-2012) data. National associations between air pollutant and health outcome were estimated for season (warm, cold vs. year-round), age (base ≥ 1, seniors > 65), and sex (females ≥ 1 and males ≥ 1) using Bayesian hierarchical models.

RESULTS

Overall, the three air pollutants were significantly associated with acute respiratory health outcomes at different lag-days. For respiratory hospitalization, the increased risks in percent changes with 95% posterior intervals for a 10-unit increase in each pollutant were: ozone (lag1, 0.7% (0.4, 0.9)), NO₂ (lag0, 0.7% (0.1, 1.4)), and PM_2.5 (lag1, 1.3% (0.7, 1.9)). For respiratory mortality: ozone (lag2, 1.2% (0.4, 1.9)), NO₂ (lag1, 2.1% (0.6, 3.5)), and PM_2.5 (lag1, 0.6% (-1.0, 2.2)). While some differences in risk were observed by season and age group, sex-specific differences were more pronounced. Compared with males, females had a higher respiratory mortality risk (1.8% (0.6, 2.9) vs 0.5% (-0.3, 1.3)) from ozone, a higher respiratory hospitalization risk (0.9% (0.0, 1.8) vs 0.6% (-0.3, 1.4)) but lower mortality risk (1.4% (-1.0, 3.7) vs 2.2% (0.4, 4.0)) from NO₂, and a lower hospitalization risk (0.7% (-0.2, 1.7) vs 1.8% (1.0, 2.6)) from PM_2.5.

CONCLUSION

This study reports significant health effects of short-term exposure to three ambient air pollutants on respiratory hospitalization (ozone≈NO₂ < PM_2.5 per-10 unit; ozone>NO₂ ≈ PM_2.5 per-IQR) and mortality (ozone≈NO₂ > PM_2.5) in Canada. Pollutant-sex-specific differences were found, but inconclusive due to limited biological and physiological explanations. Further studies are warranted to understand the pollutant-sex specific differences.

Increased average annual prevalence of upper respiratory tract infection (UTRI) in the central Indian population residing near the coal-fired thermal power plants

People are vulnerable to health risks due to particulate matter generated through the coal combustion processes. The air pollution due to the thermal power plant is a primary concern among all sources of pollution. The air pollution due to the coal-fired thermal power plant is a primary concern among all the different sources of pollution. The air quality (suspended particulate matter; SPM) modeling in the study area of central India was carried out using CALAUFF model. In addition, real-time air monitoring of particulate matter PM1, PM2.5 and PM10 was carried out in the study area. Real-time air quality monitoring data showed higher concentration of particulate matter (PM1 and PM2.5) at different locations in the study area, exceeding the regulatory limits set by NAAQS (National Ambient Air Quality Standards) and WHO (World Health Organization). Considering the most probable health impacts due to coal-fired thermal power plant, diseases such as chronic upper respiratory tract infections (URTI), and asthma were focused in this study. Hospital admission data were collected for respiratory disorders from six different public health centers (PHCs) located in the study area for the years 2012 and 2013. Average annual prevalence (AAP) of asthma at Dhapewada, Patansaongi, Chicholi, Satak, Droli and Kanhan PHCs was observed to be 0.581, 0.218, 0.201, 0.155, 0.377 and 0.198%, respectively, whereas AAP of UTRI at Dhapewada, Patansaongi, Chicholi, Satak, Droli and Kanhan PHCs was 24.961, 40.693, 0.769, 12.775, 28.605 and 14.898%, respectively. Thus, we conclude that the study population residing nearby the coal-fired thermal power plants may have an increased risk to upper respiratory tract infections (URTI) than asthma.

Comparison of hospitalization and mortality associated with short-term exposure to ambient ozone and PM2.5 in Canada

BACKGROUND

Hospitalization and mortality (H-M) have been linked to air pollution separately. However, previous studies have not adequately compared whether air pollution is a stronger risk factor for hospitalization or mortality. This study aimed to investigate differences in H-M risk from short-term ozone and PM_2.5 exposures, and determine whether differences are modified by season, age, and sex.

METHODS

Daily ozone, PM_2.5, temperature, and all-cause H-M counts (ICD-10, A00-R99) were collected for 22-24 Canadian cities for up to 29 years. Generalized additive Poisson models were employed to estimate associations between each pollutant and health outcome, which were compared across season (warm, cold, or year-round), age (all ages or seniors > 65), and sex.

RESULTS

Overall, ozone and PM_2.5 showed higher season-specific risk of mortality than hospitalization: warm-season ozone: 0.54% (95% credible interval, 0.20, 0.85) vs. 0.14% (0.02, 0.27) per 10 ppb; and year-round PM_2.5: 0.90% (0.33, 1.41) vs. 0.29% (0.03, 0.56) per 10 μg/m³. While age showed little H-M difference, sex appeared to be a modifier of H-M risk. While females had higher mortality risk, males had higher hospitalization risk: for females, ozone 0.87% (0.36, 1.35) vs. -0.03% (-0.18, 0.11) and PM_2.5 1.19% (0.40, 1.90) vs. 0.19% (-0.10, 0.47); and for males ozone 0.20% (-0.28, 0.65) vs. 0.35% (0.18, 0.51).

CONCLUSION

This study found H-M differences attributable to ozone and PM_2.5, suggesting that both are stronger risk factors for mortality than hospitalization. In addition, there were clear H-M differences by sex: specifically, females showed higher mortality risk and males showed higher hospitalization risk.

Potential roles of micronutrient deficiency and immune system dysfunction in the coronavirus disease 2019 (COVID-19) pandemic

Preliminary studies indicate that a robust immune response across different cell types is crucial in recovery from coronavirus disease 2019 (COVID-19). An enormous number of investigations point to the vital importance of various micronutrients in the interactions between the host immune system and viruses, including COVID-19. There are complex and multifaceted links among micronutrient status, the host immune response, and the virulence of pathogenic viruses. Micronutrients play a critical role in the coordinated recruitment of innate and adaptive immune responses to viral infections, particularly in the regulation of pro- and anti-inflammatory host responses. Furthermore, inadequate amounts of micronutrients not only weaken the immune system in combating viral infections, but also contribute to the emergence of more virulent strains via alterations of the genetic makeup of the viral genome. The aim of this study was to evaluate the evidence that suggests the contribution of micronutrients in the spread as well as the morbidity and mortality of COVID-19. Both the presence of micronutrient deficiencies among infected individuals and the effect of micronutrient supplementation on the immune responses and overall outcome of the disease could be of great interest when weighing the use of micronutrients in the prevention and treatment of COVID-19 infection. These investigations could be of great value in dealing with future viral epidemics.

New approaches for modeling the regional pollution in Europe

Generally, official statistical reports provide information on the pollution extent over a region using the average records from all the observation sites. In the outliers' presence, the average is not a good choice. Therefore, in this article, we propose two alternatives for replacing the average series by most significant regional series, obtained by two selection procedures. The first algorithm chooses the candidates to be utilized for the regional estimation of pollution by a data segmentation that provides the most representative value for a given time interval. Since the number of segments to be used should be prior introduced, the second algorithm proposes a version of the selection procedure based on the k-means algorithm. The performances of these methods are verified on three groups of series (carbon oxides, sulfur oxides, and nitrogen oxides) recorded in the EEA33 countries during a period of 28 years. Both algorithms give better results than the average series, in terms of mean standard errors (MSE) and mean absolute errors (MAE).

Spatial-Temporal Modelling of Disease Risk Accounting for PM2.5 Exposure in the Province of Pavia: An Area of the Po Valley

Spatio-temporal Bayesian disease mapping is the branch of spatial epidemiology interested in providing valuable risk estimates in certain geographical regions using administrative areas as statistical units. The aim of the present paper is to describe spatio-temporal distribution of cardiovascular mortality in the Province of Pavia in 2010 through 2015 and assess its association with environmental pollution exposure. To produce reliable risk estimates, eight different models (hierarchical log-linear model) have been assessed: temporal parametric trend components were included together with some random effects that allowed the accounting of spatial structure of the region. The Bayesian approach allowed the borrowing information effect, including simpler model results in the more complex setting. To compare these models, Watanabe–Akaike Information Criteria (WAIC) and Leave One Out Information Criteria (LOOIC) were applied. In the modelling phase, the relationship between the disease risk and pollutants exposure (PM2.5) accounting for the urbanisation level of each geographical unit showed a strong significant effect of the pollutant exposure (OR = 1.075 and posterior probability, or PP, >0.999, equivalent to p < 0.001). A high-risk cluster of Cardiovascular mortality in the Lomellina subareas in the studied window was identified.

Ordinary Gasoline Emissions Induce a Toxic Response in Bronchial Cells Grown at Air-Liquid Interface

Gasoline engine emissions have been classified as possibly carcinogenic to humans and represent a significant health risk. In this study, we used MucilAir™, a three-dimensional (3D) model of the human airway, and BEAS-2B, cells originating from the human bronchial epithelium, grown at the air-liquid interface to assess the toxicity of ordinary gasoline exhaust produced by a direct injection spark ignition engine. The transepithelial electrical resistance (TEER), production of mucin, and lactate dehydrogenase (LDH) and adenylate kinase (AK) activities were analyzed after one day and five days of exposure. The induction of double-stranded DNA breaks was measured by the detection of histone H2AX phosphorylation. Next-generation sequencing was used to analyze the modulation of expression of the relevant 370 genes. The exposure to gasoline emissions affected the integrity, as well as LDH and AK leakage in the 3D model, particularly after longer exposure periods. Mucin production was mostly decreased with the exception of longer BEAS-2B treatment, for which a significant increase was detected. DNA damage was detected after five days of exposure in the 3D model, but not in BEAS-2B cells. The expression of CYP1A1 and GSTA3 was modulated in MucilAir™ tissues after 5 days of treatment. In BEAS-2B cells, the expression of 39 mRNAs was affected after short exposure, most of them were upregulated. The five days of exposure modulated the expression of 11 genes in this cell line. In conclusion, the ordinary gasoline emissions induced a toxic response in MucilAir™. In BEAS-2B cells, the biological response was less pronounced, mostly limited to gene expression changes.

Describing the trend of ammonia, particulate matter and nitrogen oxides: The role of livestock activities in northern Italy during Covid-19 quarantine

Nitrogen oxides (NOx), sulphur oxides (SOx) and ammonia (NH3) are among the main contributors to the formation of secondary particulate matter (PM2.5), which represent a severe risk to human health. Even if important improvements have been achieved worldwide, traffic, industrial activities, and the energy sector are mostly responsible for NOx and SOx release; instead, the agricultural sector is mainly responsible for NH3 emissions. Due to the emergency of coronavirus disease, in Italy schools and universities have been locked down from late February 2020, followed in March by almost all production and industrial activities as well as road transport, except for the agricultural ones. This study aims to analyze NH3, PM2.5 and NOx emissions in principal livestock provinces in the Lombardy region (Brescia, Cremona, Lodi, and Mantua) to evaluate if and how air emissions have changed during this quarantine period respect to 2016-2019. For each province, meteorological and air quality data were collected from the database of the Regional Agency for the Protection of the Environment, considering both data stations located in the city and the countryside. In the 2020 selected period, PM2.5 reduction was higher compared to the previous years, especially in February and March. Respect to February, PM2.5 released in March in the city stations reduced by 19%-32% in 2016-2019 and by 21%-41% in 2020. Similarly, NOx data of 2020 were lower than in the 2016-2019 period (reduction in March respect to February of 22-42% for 2016-2019 and of 43-62% for 2020); in particular, this can be observed in city stations, because of the current reduction in anthropogenic emissions related to traffic and industrial activities. A different trend with no reductions was observed for NH3 emissions, as agricultural activities have not stopped during the lockdown. Air quality is affected by many variables, for which making conclusions requires a holistic perspective. Therefore, all sectors must play a role to contribute to the reduction of harmful pollutants.

Commuter exposure to particulate matter in urban public transportation of Xi'an, China

PURPOSE

To investigate commuter exposures to particulate matter (PM) in urban public transportation buses and subways, PM concentrations were simultaneously monitored for these two modes, over the same routes, in Xi'an, China.

METHODS

The microenvironment variabilities in each stage of the total trip were analyzed. Exposure doses for the different commute processes were estimated based on the heart rates of volunteers. Experimental measurements were taken during peak traffic hours in July and October (summer and autumn) on two typical commute routes, for a total of 36 trips. One-way ANOVA was used to analyze the effects of different variables on commuter exposures.

RESULTS

On the same route, the average PM exposure concentration of bus commuters was higher than those of subway commuters. For example, on Route 1 in the case study, the average PM10, PM2.5, and PM1 exposure concentrations of bus commuters were 71.6%, 19%, and 10.4% higher, respectively, than those of subway commuters. In the ground transportation mode, the exposure concentration of bus commuters was affected by the type of vehicle. Particle concentrations were significantly higher inside compressed natural gas (CNG) buses, than in pure electric (PE) buses, and in summer, the PM10 concentration in a CNG bus was 4.3 times higher than that in a PE bus. In a CNG bus, commuters in the back door area suffered the highest PM10 exposure concentration (179.6 μg/m3), followed by those in the rear of the carriage (142.8 μg/m3), and then those in the front door area (105.4 μg/m3).

CONCLUSION

Commuters' avoidance of ground traffic sources, effective ventilation systems in buses, and the use of screens in subway systems can all help to lower the PM exposure of commuters. For all the modes of transportation in our study, the hottest spots for PM exposure appeared in the period when commuters were waiting for transit vehicles to arrive.

Short-Term Associations of Nitrogen Dioxide (NO2) on Mortality in 18 French Cities, 2010–2014

We present an analysis of short-term associations between ambient NO2 and mortality according to cause, age-group, and period (cold and warm) in 18 areas in metropolitan France for the 2010–2014 period. Associations were estimated in each area using a generalized additive Poisson regression model, and effects were summarized in a meta-analysis. The percentage increase in mortality rate was estimated for a 10 µg m−3 increase in the NO2 level in each area for each complete calendar year and for cold (November to April) and warm periods (May to October) in each year. We found that the NO2 increase (lag of 0–1 days) was associated with a 0.75% increase of non-accidental mortality for all age-groups (95% confidence interval (CI): (0.4; 1.10)). During the warm period, this NO2 increase was associated with a 3.07% increase in non-accidental mortality in the ≥75 years old group (95% CI: 1.97; 4.18). This study supports the short-term effects of NO2 as a proxy of urban traffic pollution on mortality, even for concentrations below the maximum guideline of 40 µg m−3 set down by the European Air Quality Standards and the World Health Organization (WHO).

PM10 spatial distribution and metals speciation study in the Bilbao metropolitan area during the 2017-2018 period

Speciation of respirable particles is becoming increasingly important from an epidemiological and analytical point of view to determine the potential effects of air pollution on human health. For this reason, current laws and analytical sampling methods focus on particle size, as it turns out to be the main factor for the greater or lesser penetration into the airways. In this sense, particles of less than 10 μm in diameter (<10 μm), referred to as PM₁₀, are the particles that have a higher capacity for access to the respiratory tract and, therefore, more significant effect on them. In this sense, one of the most important factors that have a key role in the PM₁₀ atmospheric pollution effect is the dispersion effect with the direct influence of natural effects such as wind, rain, topography apart from others. In this work, PM₁₀ data extracted from the Basque Government environmental stations (19 sampling points) in the Biscay province (Basque Country, north of Spain) were combined with the results obtained from the use of self-made passive samplers (SMPS) in the same sampling points areas and subsequently, the sample analysis with a non-invasive elemental technique (Scanning Electron Microscope coupled to Energy Dispersive X-ray Spectrometry) was carried out. Thanks to this methodology, it was possible to determine a wide variety of metals in PM₁₀ such as Al, Fe, Cr, Ni, Pb, Zn, Ti, etc. Most of them present as oxides and others as part of natural aggregations such as quartz, aluminosilicates, phosphates etc.

Particulate matter (PM10) enhances RNA virus infection through modulation of innate immune responses

Sensing of pathogens by specialized receptors is the hallmark of the innate immunity. Innate immune response also mounts a defense response against various allergens and pollutants including particulate matter present in the atmosphere. Air pollution has been included as the top threat to global health declared by WHO which aims to cover more than three billion people against health emergencies from 2019 to 2023. Particulate matter (PM), one of the major components of air pollution, is a significant risk factor for many human diseases and its adverse effects include morbidity and premature deaths throughout the world. Several clinical and epidemiological studies have identified a key link between the PM existence and the prevalence of respiratory and inflammatory disorders. However, the underlying molecular mechanism is not well understood. Here, we investigated the influence of air pollutant, PM10 (particles with aerodynamic diameter less than 10 μm) during RNA virus infections using Highly Pathogenic Avian Influenza (HPAI) - H5N1 virus. We thus characterized the transcriptomic profile of lung epithelial cell line, A549 treated with PM10 prior to H5N1infection, which is known to cause severe lung damage and respiratory disease. We found that PM10 enhances vulnerability (by cellular damage) and regulates virus infectivity to enhance overall pathogenic burden in the lung cells. Additionally, the transcriptomic profile highlights the connection of host factors related to various metabolic pathways and immune responses which were dysregulated during virus infection. Collectively, our findings suggest a strong link between the prevalence of respiratory illness and its association with the air quality.

Coarse particles (PM2.5-10) and cause-specific hospitalizations in southwestern China: Association, attributable risk and economic costs

The short-term morbidity effects of the coarse particle (diameter in 2.5-10 μm, PM_2.5-10), as well as the corresponding morbidity burden and economic costs, remain understudied, especially in developing countries. This study aimed to examine the associations of PM_2.5-10 with cause-specific hospitalizations in a multi-city setting in southwestern China and assess the attributable risk and economic costs. City-specific associations were firstly estimated using generalized additive models with quasi-poisson distribution to handle over-dispersion, and then combined to obtain the regional average association. City-specific and pooled concentration-response (C-R) associations of PM_2.5-10 with cause-specific hospitalizations were also modeled. Subgroup analyses were performed by age, sex, season and region. The health and economic burden of hospitalizations for multiple outcomes due to PM_2.5-10 were further evaluated. A total of 4,407,601 non-accidental hospitalizations were collected from 678 hospitals. The estimates of percentage change in hospitalizations per 10 μg/m³ increase in PM_2.5-10 at lag01 was 0.68% (95%CI: 0.33%-1.03%) for non-accidental causes, 0.86% (95% CI: 0.36%-1.37%) for circulatory diseases, 1.52% (95% CI: 1.00%-2.05%) for respiratory diseases, 1.08% (95% CI: 0.47%-1.69%) for endocrine diseases, 0.66% (95% CI: 0.12%-1.21%) for nervous system diseases, and 0.84% (95% CI: 0.42%-1.25%) for genitourinary diseases, respectively. The C-R associations of PM_2.5-10 with cause-specific hospitalizations suggested some evidence of nonlinearity, except for endocrine diseases. Meanwhile, the adverse effects were modified by age and season. Overall, about 0.70% (95% CI: 0.35%-1.06%) of non-accidental hospitalizations and 0.78% (95% CI: 0.38%-1.17%) of total hospitalization expenses could be attributed to PM_2.5-10. The largest morbidity burden and economic costs were observed in respiratory diseases. Our findings indicate that PM_2.5-10 exposure may increase the risk of hospitalizations for multiple outcomes, and account for considerable morbidity and economic burden.

The effect of air-pollution and weather exposure on mortality and hospital admission and implications for further research: A systematic scoping review

BACKGROUND

Air-pollution and weather exposure beyond certain thresholds have serious effects on public health. Yet, there is lack of information on wider aspects including the role of some effect modifiers and the interaction between air-pollution and weather. This article aims at a comprehensive review and narrative summary of literature on the association of air-pollution and weather with mortality and hospital admissions; and to highlight literature gaps that require further research.

METHODS

We conducted a scoping literature review. The search on two databases (PubMed and Web-of-Science) from 2012 to 2020 using three conceptual categories of "environmental factors", "health outcomes", and "Geographical region" revealed a total of 951 records. The narrative synthesis included all original studies with time-series, cohort, or case cross-over design; with ambient air-pollution and/or weather exposure; and mortality and/or hospital admission outcomes.

RESULTS

The final review included 112 articles from which 70 involved mortality, 30 hospital admission, and 12 studies included both outcomes. Air-pollution was shown to act consistently as risk factor for all-causes, cardiovascular, respiratory, cerebrovascular and cancer mortality and hospital admissions. Hot and cold temperature was a risk factor for wide range of cardiovascular, respiratory, and psychiatric illness; yet, in few studies, the increase in temperature reduced the risk of hospital admissions for pulmonary embolism, angina pectoris, chest, and ischemic heart diseases. The role of effect modification in the included studies was investigated in terms of gender, age, and season but not in terms of ethnicity.

CONCLUSION

Air-pollution and weather exposure beyond certain thresholds affect human health negatively. Effect modification of important socio-demographics such as ethnicity and the interaction between air-pollution and weather is often missed in the literature. Our findings highlight the need of further research in the area of health behaviour and mortality in relation to air-pollution and weather, to guide effective environmental health precautionary measures planning.

The 10-Year Study of the Impact of Particulate Matters on Mortality in Two Transit Cities in North-Eastern Poland (PL-PARTICLES)

The detrimental influence of air pollution on mortality has been established in a series of studies. The majority of them were conducted in large, highly polluted cities-there is a lack of studies from small, relatively clean regions. The aim was to analyze the short-term impact of particulate matters (PMs) on mortality in north-eastern Poland. Time-stratified case-crossover design was performed for mortality in years 2008-2017. Daily concentrations of PM_2.5 (28.4 µg/m³, interquartile range (IQR) = 25.2) vs. (12.6 µg/m³, IQR = 9.0) and PM₁₀ (29.0 µg/m³, IQR = 18.0) vs. (21.7 µg/m³, IQR = 14.5) were higher in Łomża than Suwałki (p < 0.001). Impact of PM_2.5 on mortality was recorded in Łomża (odds ratio (OR) for IQR increase 1.061, 1.017-1.105, p = 0.06, lag 0) and Suwałki (OR for IQR increase 1.044, 1.001-1.089, p = 0.004, lag 0). PM₁₀ had an impact on mortality in Łomża (OR for IQR increase 1.028, 1.000-1.058, p = 0.049, lag 1). Cardiovascular mortality was affected by increase of PM_2.5 in Łomża (1.086, 1.020-1.156, p = 0.01) and Suwałki (1.085, 1.005-1.171, p = 0.04). PM_2.5 had an influence on respiratory mortality in Łomża (1.163, 1.021-1.380, p = 0.03, lag 1). In the whole studied region, despite differences in the air quality, the influence of PMs on mortality was observed.

Assessing the relationship between ground levels of ozone (O3) and nitrogen dioxide (NO2) with coronavirus (COVID-19) in Milan, Italy

This paper investigates the correlation between the high level of coronavirus SARS-CoV-2 infection accelerated transmission and lethality, and surface air pollution in Milan metropolitan area, Lombardy region in Italy. For January-April 2020 period, time series of daily average inhalable gaseous pollutants ozone (O3) and nitrogen dioxide (NO2), together climate variables (air temperature, relative humidity, wind speed, precipitation rate, atmospheric pressure field and Planetary Boundary Layer) were analyzed. In spite of being considered primarily transmitted by indoor bioaerosols droplets and infected surfaces or direct human-to-human personal contacts, it seems that high levels of urban air pollution, and climate conditions have a significant impact on SARS-CoV-2 diffusion. Exhibited positive correlations of ambient ozone levels and negative correlations of NO2 with the increased rates of COVID-19 infections (Total number, Daily New positive and Total Deaths cases), can be attributed to airborne bioaerosols distribution. The results show positive correlation of daily averaged O3 with air temperature and inversely correlations with relative humidity and precipitation rates. Viral genome contains distinctive features, including a unique N-terminal fragment within the spike protein, which allows coronavirus attachment on ambient air pollutants. At this moment it is not clear if through airborne diffusion, in the presence of outdoor and indoor aerosols, this protein "spike" of the new COVID-19 is involved in the infectious agent transmission from a reservoir to a susceptible host during the highest nosocomial outbreak in some agglomerated industrialized urban areas like Milan is. Also, in spite of collected data for cold season (winter-early spring) period, when usually ozone levels have lower values than in summer, the findings of this study support possibility as O3 can acts as a COVID-19 virus incubator. Being a novel pandemic coronavirus version, it might be ongoing during summer conditions associated with higher air temperatures, low relative humidity and precipitation levels.

Satellite-detected tropospheric nitrogen dioxide and spread of SARS-CoV-2 infection in Northern Italy

Following the outbreak of Severe Acute Respiratory Syndrome CoronaVirus 2 (SARS-CoV-2) last December 2019 in China, Italy was the first European country to be severely affected, with the first local case diagnosed on 20 February 2020. The virus spread quickly, particularly in the North of Italy, with three regions (Lombardy, Veneto and Emilia-Romagna) being the most severely affected. These three regions accounted for >80% of SARS-CoV-2 positive cases when the tight lockdown was established (March 8). These regions include one of Europe's areas of heaviest air pollution, the Po valley. Air pollution has been recently proposed as a possible risk factor of SARS-CoV-2 infection, due to its adverse effect on immunity and to the possibility that polluted air may even carry the virus. We investigated the association between air pollution and subsequent spread of the SARS-CoV-2 infection within these regions. We collected NO2 tropospheric levels using satellite data available at the European Space Agency before the lockdown. Using a multivariable restricted cubic spline regression model, we compared NO2 levels with SARS-CoV-2 infection prevalence rate at different time points after the lockdown, namely March 8, 22 and April 5, in the 28 provinces of Lombardy, Veneto and Emilia-Romagna. We found little association of NO2 levels with SARS-CoV-2 prevalence up to about 130 μmol/m2, while a positive association was evident at higher levels at each time point. Notwithstanding the limitations of the use of aggregated data, these findings lend some support to the hypothesis that high levels of air pollution may favor the spread of the SARS-CoV-2 infection.

Impact of COVID-19 outbreak measures of lockdown on the Italian Carbon Footprint

Stringent lockdown measures implemented in Italy to mitigate the spread of COVID-19 are generating unprecedented economic impacts. However, the environmental consequences associated with the temporary shutdown and recovery of industrial and commercial activities are still not fully understood. Using the well-known carbon footprint (CF) indicator, this paper provides a comprehensive estimation of environmental effects due to the COVID-19 outbreak lockdown measures in Italy. Our aim was to quantify the CF associated with the consumption of energy by any economic activity and region in Italy during the lockdown, and then compare these environmental burdens with the CF calculated for analogous periods from 2015 to 2019 (~March and April). Complementarily, we also conducted a scenario analysis to estimate the post-lockdown CF impact in Italy. A consumption-based approach was applied according to the principles of the established Life Cycle Assessment method. The CF was therefore quantified as a sum of direct and indirect greenhouse gases (GHGs) released from domestically produced and imported energy metabolism flows, excluding the exports. Our findings indicate that the CF in the lockdown period is ~-20% lower than the mean CF calculated for the past. This means avoided GHGs in between ~5.6 and ~10.6 Mt CO₂e. Results further suggest that a tendency occurs towards higher impact savings in the Northern regions, on average ~230 kt CO₂e of GHGs avoided by province (against ~110-130 kt CO₂e in central and Southern provinces). Not surprisingly, these are the utmost industrialized areas of Italy and have been the ones mostly affected by the outbreak. Despite our CF estimates are not free of uncertainties, our research offers quantitative insights to start understanding the magnitude generated by such an exceptional lockdown event in Italy on climate change, and to complement current scientific efforts investigating the relationships between air pollution and the spread of COVID-19.

Air pollution by NO2 and PM2.5 explains COVID-19 infection severity by overexpression of angiotensin-converting enzyme 2 in respiratory cells: a review

Many major cities that witnessed heavy air pollution by nitrogen dioxide (NO2) and particulate matter (PM) have experienced a high rate of infection and severity of the coronavirus disease pandemic (COVID-19). This phenomenon could be explained by the overexpression of the angiotensin converting enzyme 2 (ACE-2) on epithelial cell surfaces of the respiratory tract. Indeed, ACE-2 is a receptor for coronaviruses including the severe acute respiratory syndrome coronavirus 1 and 2 (SARS-CoV), and ACE-2 is overexpressed under chronic exposure to air pollution such as NO2 and PM2.5. In this review, we explain that ACE-2 acts as the sole receptor for the attachment of the SARS-CoV-2 via its spike protein. The fact that respiratory and vascular epithelial cells express ACE-2 has been previously observed during the 2003 epidemic of the SARS-CoV-1 in China, and during the 2012 Middle East respiratory syndrome in Saudi Arabia. High ACE-2 expression in respiratory epithelial cells under air pollution explains the positive correlation between the severity in COVID-19 patients and elevated air pollution, notably high NO2 and PM2.5 levels. Specific areas in India, China, Italy, Russia, Chile and Qatar that experience heavy air pollution also show high rates of COVID-19 infection and severity. Overall, we demonstrate a link between NO2 emissions, PM2.5 levels, ACE-2 expression and COVID-19 infection severity. Therefore, air pollution should be reduced in places where confirmed cases of COVID-19 are unexpectedly high.

Seasonal variation in health impacts associated with visibility in Beijing, China

Visibility has been continuously and stably observed for more than half a century, while particulate matter with an aerodynamic diameter ≤ 2.5 μm (PM_2.5) was not introduced to the national monitoring system in China until 2013. It is a scientific issue as to whether visibility can be used as an alternative to assess the health risks of air pollution in periods and areas without pollutant monitoring data. A generalized additive model (GAM) was adopted to estimate the impacts of seasonal changes in visibility on mortality in Beijing, China. Moreover, we estimated the contributions of particulate matter in the health effects of visibility by adjusting for dry extinction coefficient (β_dryext) and PM_2.5 in the model, respectively. We found that the acute health impacts of visibility varied by season, with the highest risks in winter. For respiratory mortality, the effect estimates per 1 km decrease in visibility were 0.40% (95% CI: 0.17-0.62%) in spring, 0.10% (95% CI: -0.14-0.34%) in summer, 0.27% (95% CI: 0.09-0.45%) in autumn, and 0.62% (95% CI: 0.38-0.85%) in winter. For cardiovascular mortality, the effect estimates per 1 km decrease in visibility were 0.20% (95% CI: 0.08-0.31%) in spring, 0.16% (95% CI: 0.04-0.27%) in summer, 0.25% (95% CI: 0.13-0.37%) in autumn, and 0.24% (95% CI: 0.13-0.35%) in winter. The seasonal pattern of health impacts related to visibility reflected the seasonal variations in the characteristics of air pollution emission sources and meteorological conditions that are unfavorable for pollutant dispersion. Particulate matter, particularly PM_2.5, made significant contributions to the health impacts of visibility. The results indicated that controlling pollutant emissions in winter would be of significant importance to improve air quality and mitigate the health hazard of air pollution in Beijing. Our study also provides further evidence on the feasibility of using visibility to assess the health impacts of particulate matter pollution.

The Effects of Air Pollution on COVID-19 Related Mortality in Northern Italy

Long-term exposure to ambient air pollutant concentrations is known to cause chronic lung inflammation, a condition that may promote increased severity of COVID-19 syndrome caused by the novel coronavirus (SARS-CoV-2). In this paper, we empirically investigate the ecologic association between long-term concentrations of area-level fine particulate matter (PM2.5) and excess deaths in the first quarter of 2020 in municipalities of Northern Italy. The study accounts for potentially spatial confounding factors related to urbanization that may have influenced the spreading of SARS-CoV-2 and related COVID-19 mortality. Our epidemiological analysis uses geographical information (e.g., municipalities) and negative binomial regression to assess whether both ambient PM2.5 concentration and excess mortality have a similar spatial distribution. Our analysis suggests a positive association of ambient PM2.5 concentration on excess mortality in Northern Italy related to the COVID-19 epidemic. Our estimates suggest that a one-unit increase in PM2.5 concentration (µg/m3) is associated with a 9% (95% confidence interval: 6-12%) increase in COVID-19 related mortality.

Evidence-Based Considerations Exploring Relations between SARS-CoV-2 Pandemic and Air Pollution: Involvement of PM2.5-Mediated Up-Regulation of the Viral Receptor ACE-2

The COVID-19/SARS-CoV-2 pandemic struck health, social and economic systems worldwide, and represents an open challenge for scientists -coping with the high inter-individual variability of COVID-19, and for policy makers -coping with the responsibility to understand environmental factors affecting its severity across different geographical areas. Air pollution has been warned of as a modifiable factor contributing to differential SARS-CoV-2 spread but the biological mechanisms underlying the phenomenon are still unknown. Air quality and COVID-19 epidemiological data from 110 Italian provinces were studied by correlation analysis, to evaluate the association between particulate matter (PM)2.5 concentrations and incidence, mortality rate and case fatality risk of COVID-19 in the period 20 February-31 March 2020. Bioinformatic analysis of the DNA sequence encoding the SARS-CoV-2 cell receptor angiotensin-converting enzyme 2 (ACE-2) was performed to identify consensus motifs for transcription factors mediating cellular response to pollutant insult. Positive correlations between PM2.5 levels and the incidence (r = 0.67, p < 0.0001), the mortality rate (r = 0.65, p < 0.0001) and the case fatality rate (r = 0.7, p < 0.0001) of COVID-19 were found. The bioinformatic analysis of the ACE-2 gene identified nine putative consensus motifs for the aryl hydrocarbon receptor (AHR). Our results confirm the supposed link between air pollution and the rate and outcome of SARS-CoV-2 infection and support the hypothesis that pollution-induced over-expression of ACE-2 on human airways may favor SARS-CoV-2 infectivity.

Wheat and chaffs in the interpretation of the current COVID19 outbreak in Italy

The COVID19 outbreak in Italy is still a big concern. The Italian Government has recommended citizens to respect faithfully any compulsory legal disposition in order to stay home and so contributing in escaping viral contacts and slowing down epidemic. Emergency has raised a widely animated debate about how to read and comprehend the daily case numbers, the medical and caregivers availability, the needs to swab asymptomatic subjects. In this review the authors discuss about the many wheat and chaffs of how this virus disease is addressed .