Vulnerability and Burden of All-Cause Mortality Associated with Particulate Air Pollution during COVID-19 Pandemic: A Nationwide Observed Study in Italy
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Abstract
Background: Limited evidence is available on the health effects of particulate matter (PM including PM2.5 with an aerodynamic diameter ≤ 2.5 μm; PM10, ≤ 10 μm; PM2.5–10, 2.5–10 μm) during the pandemic of COVID-19 in Italy. The aims of the study were to examine the associations between all-cause mortality and PM in the pandemic period and compare them to the normal periods (2015–2019). Methods: We collected daily data regarding all-cause mortality (stratified by age and gender), and PM concentrations for 107 Italian provinces from 1 January 2015 to 31 May 2020. A time-stratified case-cross design with the distributed lag non-linear model was used to examine the association between PM and all-cause mortality. We also compared the counts and fractions of death attributable to PM in two periods. Results: Italy saw an increase in daily death counts while slight decreases in PM concentrations in pandemic period. Each 10 µg/m3 increase in PM was associated with much higher increase in daily all-cause mortality during the pandemic period compared to the same months during 2015–2019 (increased mortality rate: 7.24% (95%CI: 4.84%, 9.70%) versus 1.69% (95%CI: 1.12%, 2.25%) for PM2.5; 3.45% (95%CI: 2.58%, 4.34%) versus 1.11% (95%CI: 0.79%, 1.42%) for PM10; 4.25% (95%CI: 2.99%, 5.52%) versus 1.76% (95%CI: 1.14%, 2.38%) for PM2.5–10). The counts and fractions of deaths attributable to PM were higher in 2020 for PM2.5 (attributable death counts: 20,062 versus 3927 per year in 2015–2019; attributable fractions: 10.2% versus 2.4%), PM10 (15,112 versus 3999; 7.7% versus 2.5%), and PM2.5–10 (7193 versus 2303; 3.7% versus 1.4%). Conclusion: COVID-19 pandemic increased the vulnerability and excess cases of all-cause mortality associated with short-term exposure to PM2.5, PM2.5–10, and PM10 in Italy, despite a decline in air pollution level.
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SciScore for 10.1101/2020.10.02.20206052: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
NIH rigor criteria are not applicable to paper type.Table 2: Resources
No key resources detected.
Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:There are some limitations to this study. First, like most case-crossover or time-series studies, we used province-level air pollution to represent the individual-level exposure, which is likely to cause random exposure assessment error and thus underestimate the PM-mortality associations. However, since the same design was applied to …
SciScore for 10.1101/2020.10.02.20206052: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
NIH rigor criteria are not applicable to paper type.Table 2: Resources
No key resources detected.
Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:There are some limitations to this study. First, like most case-crossover or time-series studies, we used province-level air pollution to represent the individual-level exposure, which is likely to cause random exposure assessment error and thus underestimate the PM-mortality associations. However, since the same design was applied to the 2020 and 2015-2019 period, this error is not likely to affect our main findings. Second, we were not able to assess the actual indoor exposures to PM, which might be important because people would increase the indoor time during the lockdown period. Finally, we cannot exclude the COVID-19 deaths from our analyses because the daily data were not available at province level. Therefore, we were uncertain about whether the increase in PM-mortality association was due to COVID-19 deaths or deaths due to other causes. In conclusion, with a large nationwide data set covering 107 Italian provinces, we observed significantly increased impacts of PM on all-cause mortality during the pandemic period compared to pre-COVID-19 periods. This suggests the historical exposure-response relationship between PM and mortality may underestimate the health impacts of PM during the COVID-19 pandemic, although air pollution concentrations declined. To date, the second wave of pandemic is ongoing in many Europe countries and no sign shows the end of the COVID-19 pandemic worldwide. Therefore, we would expect our findings to be helpful to guide future public health po...
Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
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- No protocol registration statement was detected.
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