Department of Mechanical and Industrial Engineering, University of Brescia, Via Branze 38, 25123, Brescia, Italy.
Department of Molecular and Translational Medicine, University of Brescia, Viale Europa 11, 25123, Brescia, Italy.
Environ Res. 2021 Apr;195:110777. doi: 10.1016/j.envres.2021.110777. Epub 2021 Jan 22.
Lombardy, the most populated and industrialized Italian region, was the epicentre of the first wave (March and April 2020) of COVID-19 in Italy and it is among the most air polluted areas of Europe. We carried out an ecological study to assess the association between long-term exposure to particulate matter (PM) and nitrogen dioxide (NO) on COVID-19 incidence and all-cause mortality after accounting for demographic, socioeconomic and meteorological variables. The study was based on publicly available data. Multivariable negative binomial mixed regression models were fitted, and results were reported in terms of incidence rate ratios (IRRs) and standardized mortality ratios (SMR). The effect of winter temperature and humidity was modelled through restricted cubic spline. Data from 1439 municipalities out of 1507 (95%) were included in the analyses, leading to a total of 61,377 COVID-19 cases and 40,401 deaths from all-causes collected from February 20th to April 16th and from March 1st to April 30th, 2020, respectively. Several demographic and socioeconomic variables resulted significantly associated with COVID-19 incidence and all-cause mortality in a multivariable fashion. An increase in average winter temperature was associated with a nonlinear decrease in COVID-19 incidence and all-cause mortality, while an opposite trend emerged for the absolute humidity. An increase of 10 μg/m in the mean annual concentrations of PM and PM over the previous years was associated with a 58% and 34% increase in COVID-19 incidence rate, respectively. Similarly, a 10 μg/m increase of annual mean PM concentration was associated with a 23% increase in all-cause mortality. An inverse association was found between NO levels and COVID-19 incidence and all-cause mortality. Our ecological study showed that exposure to PM was significantly associated with the COVID-19 incidence and excess mortality during the first wave of the outbreak in Lombardy, Italy.
伦巴第大区是意大利人口最多和工业化程度最高的地区，也是意大利 COVID-19 第一波疫情（2020 年 3 月至 4 月）的震中，同时也是欧洲污染最严重的地区之一。我们进行了一项生态学研究，以评估在考虑人口统计学、社会经济和气象变量后，长期暴露于颗粒物（PM）和二氧化氮（NO）与 COVID-19 发病率和全因死亡率之间的关联。该研究基于公开可得的数据。使用多变量负二项混合回归模型进行拟合，并以发病率比（IRR）和标准化死亡率比（SMR）报告结果。冬季温度和湿度的影响通过限制立方样条进行建模。从 1507 个城市中的 1439 个（95%）收集了 2020 年 2 月 20 日至 4 月 16 日和 3 月 1 日至 4 月 30 日期间的 COVID-19 病例共 61377 例，全因死亡 40401 例。在多变量模型中，几个人口统计学和社会经济变量与 COVID-19 发病率和全因死亡率显著相关。冬季平均温度的升高与 COVID-19 发病率和全因死亡率呈非线性下降相关，而绝对湿度则呈现相反的趋势。前几年平均年浓度中 PM 和 PM 增加 10μg/m，分别与 COVID-19 发病率增加 58%和 34%相关。同样，PM 年平均浓度增加 10μg/m 与全因死亡率增加 23%相关。NO 水平与 COVID-19 发病率和全因死亡率呈负相关。我们的生态学研究表明，暴露于 PM 与意大利伦巴第大区 COVID-19 爆发第一波期间的发病率和超额死亡率显著相关。
