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Regional and global contributions of air pollution to risk of death from COVID-19
Open accessAbstract
Aims: The risk of mortality from the coronavirus disease that emerged in 2019 (COVID-19) is increased by comorbidity from cardiovascular and pulmonary diseases. Air pollution also causes excess mortality from these conditions. Analysis of the first severe acute respiratory syndrome coronavirus (SARS-CoV-1) outcomes in 2003, and preliminary investigations of those for SARS-CoV-2 since 2019, provide evidence that the incidence and severity are related to ambient air pollution. We estimated the fraction of COVID-19 mortality that is attributable to the long-term exposure to ambient fine particulate air pollution. Methods and results: We characterized global exposure to fine particulates based on satellite data, and calculated the anthropogenic fraction with an atmospheric chemistry model. The degree to which air pollution influences COVID-19 mortality was derived from epidemiological data in the USA and China. We estimate that particulate air pollution contributed ∼15% (95% confidence interval 7–33%) to COVID-19 mortality worldwide, 27% (13 – 46%) in East Asia, 19% (8–41%) in Europe, and 17% (6–39%) in North America. Globally, ∼50–60% of the attributable, anthropogenic fraction is related to fossil fuel use, up to 70–80% in Europe, West Asia, and North America. Conclusion: Our results suggest that air pollution is an important cofactor increasing the risk of mortality from COVID-19. This provides extra motivation for combining ambitious policies to reduce air pollution with measures to control the transmission of COVID-19.
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Metadata
- Authors
- Pozzer, A., Dominici, F., Haines, A., Witt, C., Münzel, T., & Lelieveld, J.
- Affiliations
- The Abdus Salam International Centre for Theoretical Physics (ICTP) (IT)
- Harvard University (US)
- London School of Hygiene & Tropical Medicine (GB)
- Charité – Universitätsmedizin Berlin (DE)
- University Medical Center of the Johannes Gutenberg University Mainz (DE)
- Cyprus Institute (CY)
- Corresponding author
- Münzel, Thomas
- Lelieveld, Jos
- Venue
- Cardiovascular Research
- Publisher
- Oxford University Press (OUP)
- Published
- 2020-10-26
- Volume
- 116
- Issue
- 14
- Pages
- 2247-2253
- ISSN
- 0008-6363 (ISSN-L)
- 1755-3245
- PMC
- PMC7797754
- OpenAlex
- W3105596189
- Cited by
- 463
- References
- 65
- Citations by year
- 2026: 13 · 2025: 11 · 2024: 26 · 2023: 67 · 2022: 102 · 2021: 129 · 2020: 114
- FWCI
- 41.22
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Cardiovascular Research (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion, other-oa)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- MPG.PuRe (Max Planck Society) (submittedVersion)
- Funders
- DZHK
- German Center for Cardiovascular Research
- Partner Site Rhine-Main
- Topics
- Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Air Quality and Health Impacts
- Physical Sciences › Environmental Science › Global and Planetary Change › COVID-19 impact on air quality
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Infection Control and Ventilation
- Keywords
- COVID-19 mortality, air pollution, PM2.5, ambient air pollution exposure, attributable fraction, fossil fuel consumption, anthropogenic emissions, cardiovascular comorbidity, SARS-CoV-2, air quality policy
- MeSH terms
- COVID-19, Air Pollutants, Air Pollution, Asia, Environmental Exposure, Europe, Humans, Models, Theoretical, North America, Risk Factors, Time Factors, Global Health, Risk Assessment, Particulate Matter
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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