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Cited by 463Air Quality and Health ImpactsCOVID-19 impact on air qualityInfection Control and Ventilation

The DOI matches its Crossref record; 64 of the 65 references it cites were found in a registry or an index.

Regional and global contributions of air pollution to risk of death from COVID-19

Open access
Pozzer, Andrea, Dominici, Francesca, Haines, Andy, Witt, Christian, Münzel, Thomas, Lelieveld, Jos·2020·Cardiovascular Research
DOI 10.1093/cvr/cvaa288PMC PMC7797754
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Abstract

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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Crossref · 10.1093/cvr/cvaa288

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Figures

Figure 1 Exposure-response dependencies, based on a log-normal relationship28. The relative risk (or hazard ratio), from which the attributable fraction has been derived, is based on mortality rate ratios attributed to air pollution in the COVID-19 pandemic7 and the SARS epidemic17, indicated by the black bullet and squares, respectively. The triangle represents the threshold concentration below which PM2.5does not have health implications2. The red curves depict the function fitted to the data from COVID-19 in the USA only7, plus the threshold2 (triangle and bullet). The blue curves depict the function fitted to all data2,7,17. The colored ranges show the 95% confidence intervals, which are wider after including the SARS-related results (blue), mostly due to uncertainty from converting Chinese API’s into PM2.5concentrations (black squares).
Figure 1 Exposure-response dependencies, based on a log-normal relationship28. The relative risk (or hazard ratio), from which the attributable fraction has been derived, is based on mortality rate ratios attributed to air pollution in the COVID-19 pandemic7 and the SARS epidemic17, indicated by the black bullet and squares, respectively. The triangle represents the threshold concentration below which PM2.5does not have health implications2. The red curves depict the function fitted to the data from COVID-19 in the USA only7, plus the threshold2 (triangle and bullet). The blue curves depict the function fitted to all data2,7,17. The colored ranges show the 95% confidence intervals, which are wider after including the SARS-related results (blue), mostly due to uncertainty from converting Chinese API’s into PM2.5concentrations (black squares).CC BY-NC · PubMed Central
Figure 2 Estimated percentages of COVID-19 mortality attributed to air pollution from all anthropogenic sources (top), and from fossil fuel use only (bottom). The regions with high attributable fractions coincide with high levels of air pollution. The mapped results account for population density, thus reflecting population weighted exposure to PM2.5.
Figure 2 Estimated percentages of COVID-19 mortality attributed to air pollution from all anthropogenic sources (top), and from fossil fuel use only (bottom). The regions with high attributable fractions coincide with high levels of air pollution. The mapped results account for population density, thus reflecting population weighted exposure to PM2.5.CC BY-NC · PubMed Central

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  1. Ostro, 2004, World Health Organization Protection of the Human Environment

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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
ORCID
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
DOI
10.1093/cvr/cvaa288
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
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

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