Population Response to Air Pollution and the Risk of Coronavirus Disease in Chinese Cities during the Early Pandemic Period

• Published in: International journal of environmental research and public health 2021-02, Vol.18 (5), p.2248
• Main Authors: Yoon, Miryoung, Kim, Jong-Hun, Sung, Jisun, Lim, Ah-Young, Hwang, Myung-Jae, Kim, Eun-Hye, Cheong, Hae-Kwan
• Format: Article
• Language: English
• Subjects: Air Pollution - adverse effects; Air Pollution - analysis; China - epidemiology; Cities; COVID-19 - epidemiology; Humans; Pandemics; Particulate Matter - adverse effects; Particulate Matter - analysis
• ISSN: 1660-4601; 1661-7827; 1660-4601
• DOI: 10.3390/ijerph18052248

Health behavior is a critical measure in controlling the coronavirus disease 2019 (COVID-19) pandemic. We estimated the effect of health behaviors against air pollution on reducing the risk of COVID-19 during the initial phase of the pandemic. The attack rates of COVID-19 in 159 mainland Chinese cities during the first 2 weeks after the closure of major cities was estimated; air pollution level as a surrogate indicator of the mask-wearing rate. Data on air pollution levels and meteorologic factors 2 weeks prior to the closure were obtained. The attack rate was compared with the level of air pollution using a generalized linear model after adjusting for confounders. When fine particulates (PM ) and nitrogen dioxide (NO ) levels increased by one unit of air quality index (AQI), the infection risk decreased by 0.7% and 3.4%, respectively. When PM levels exceeded 150 (level 4), the infection risk decreased (relative risk, RR = 0.635, 95% confidence interval, CI: 0.442 to 0.912 for level 4; RR = 0.529, 95% CI: 0.337 to 0.830 for level 5; respectively). After controlling for the number of high-speed railway routes, when PM and NO levels increased by one AQI, relative risk for PM and NO was 0.990 (95% CI, 0.984 to 0.997) and 0.946 (95% CI, 0.911 to 0.982), respectively, demonstrating a consistently negative association. It is postulated that, during the early phase of the pandemic, the cities with higher air pollution levels may represent the higher practice of mask-wearing to protect from air pollution, which could have acted as a barrier to the transmission of the virus. This study highlights the importance of health behaviors, including mask-wearing for preventing infections.