Air Pollution and Influenza Incidence: Evidence from Highly Polluted Countries
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Abstract
Background: Air pollution has become a serious threat to public health. Epidemiological and clinical evidence in recent years has shown air pollutants are associated with respiratory diseases. We aimed to analyze the impact of environmental factors on influenza incidence by examining the most polluted countries in the world.
Methods: To analyze the relationship between environmental factors and influenza incidence in eighteen countries, we used a system generalized method of moments (GMM) using data from 2010 to 2020.
Results: The results suggest a positive effect of air pollution (PM2.5 and NO2) and population density on the incidence of influenza. While government health expenditures and education have a negative effect on influenza in the studied countries.
Conclusion: Our results confirmed the importance of environmental and social factors in the incidence of influenza. Furthermore, our results are interesting and informative for policymakers to design public health policies synchronized with other policies such as education, industrial, and environmental policies, for better management of influenza.
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5. Basith S, Manavalan B, Shin TH, et al (2022). The impact of fine particulate matter 2.5 on the cardiovascular system: a review of the invisible killer. Nanomaterials (Basel), 12(15):2656.
6. Anwar A, Ullah I, Younis M, Flahault A (2021). Impact of air pollution (PM2. 5) on child mortality: Evidence from sixteen Asian countries. Int J Environ Res Public Health, 18(12):6375.
7. Manisalidis I, Stavropoulou E, Stavropoulos A, et al (2020). Environmental and health impacts of air pollution: a review. Front Public Health, 8:14.
8. Lavigne E, Burnett RT, Stieb DM, et al (2018). Fine particulate air pollution and adverse birth outcomes: effect modification by regional nonvolatile oxidative potential. Environ Health Perspect, 126(07):077012.
9. Zhang X, Fan C, Ren Z, et al (2020). Maternal PM 2.5 exposure triggers preterm birth: a cross-sectional study in Wuhan, China. Glob Health Res Policy, 5:17.
10. Loaiza-Ceballos MC, Marin-Palma D, Zapata W, et al (2022). Viral respiratory infections and air pollutants. Air Qual Atmos Health, 15(1):105-14.
11. Wang X, Cai J, Liu X, et al (2023). Impact of PM2. 5 and ozone on incidence of influenza in Shijiazhuang, China: a time-series study. Environ Sci Pollut Res, 30(4):10426-43.
12. World Health Organization (2023). Influenza (Seasonal). Available From: https://www.who.int/news-room/fact-sheets/detail/influenza-(seasonal)
13. Yang J, Yang Z, Qi L, et al (2023). Influence of air pollution on influenza-like illness in China: a nationwide time-series analysis. EBioMedicine, 87: 104421.
14. Qi L, Gao Y, Yang J, et al (2020). The burden of influenza and pneumonia mortality attributable to absolute humidity among elderly people in Chongqing, China, 2012–2018. Sci Total Environ, 716:136682.
15. Guerrisi C, Ecollan M, Souty C, et al (2019). Factors associated with influenza-like-illness: a crowdsourced cohort study from 2012/13 to 2017/18. BMC Public Health, 19:879.
16. Matsuki E, Kawamoto S, Morikawa Y, et al (2023). The impact of cold ambient temperature in the pattern of influenza virus infection. Open Forum Infect Dis, 10(2): ofad039.
17. Sun R, Tao J, Tang N, et al (2024). Air Pollution and Influenza: A Systematic Review and Meta-Analysis. Iran J Public Health, 53(1):1-11.
18. Liu XX, Li Y, Qin G, et al (2019). Effects of air pollutants on occurrences of influenza-like illness and laboratory-confirmed influenza in Hefei, China. Int J Biometeorol, 63:51-60.
19. Carlier FM, de Fays C, Pilette C (2021). Epithelial barrier dysfunction in chronic respiratory diseases. Front Physiol, 12:691227.
20. Lee PH, Park S, Lee YG, et al (2021). The impact of environmental pollutants on barrier dysfunction in respiratory disease. Allergy Asthma Immunol Res, 13(6):850-862.
21. Xu Z, Hu W, Williams G, et al (2013). Air pollution, temperature and pediatric influenza in Brisbane, Australia. Environ Int, 59:384-8.
22. Amuakwa-Mensah F, Marbuah G, Mubanga M (2017). Climate variability and infectious diseases nexus: Evidence from Sweden. Infect Dis Model, 2(2):203-17.
23. Gujrati D. Basic Econometrics: Hoboken: Prentice Hall; 2022.
24. Roodman D (2009). How to do xtabond2: An introduction to difference and system GMM in Stata. Stata J, 9(1):86-136.
25. Croft DP, Zhang W, Lin S, et al (2020). Associations between source-specific particulate matter and respiratory infections in New York state adults. Environ Sci Technol, 54(2):975-84.
26. Chen Y, Hou W, Hou W, et al (2023). Lagging effects and prediction of pollutants and their interaction modifiers on influenza in northeastern China. BMC Public Health, 23(1):1826.
27. Rohde RA, Muller RA (2015). Air pollution in China: mapping of concentrations and sources. PLoS One, 10(8):e0135749.
28. Bălă G-P, Râjnoveanu R-M, Tudorache E, et al (2021). Air pollution exposure—the (in) visible risk factor for respiratory diseases. Environ Sci Pollut Res, 28(16):19615-28.
29. Zhou Z, Shuai X, Lin Z, et al (2023). Association between particulate matter (PM) 2· 5 air pollution and clinical antibiotic resistance: a global analysis. Lancet Planet Health, 7(8):e649-e59.
30. Schlesinger RB (2007). The health impact of common inorganic components of fine particulate matter (PM2. 5) in ambient air: a critical review. Inhal Toxicol, 19(10):811-32.
31. Chen G, Zhang W, Li S, et al (2017). The impact of ambient fine particles on influenza transmission and the modification effects of temperature in China: a multi-city study. Environ Int, 98:82-8.
32. Toczylowski K, Wietlicka-Piszcz M, Grabowska M, et al (2021). Cumulative effects of particulate matter pollution and meteorological variables on the risk of influenza-like illness. Viruses, 13(4):556.
33. Tao RJ, Cao WJ, Li MH, et al (2020). PM2. 5 compromises antiviral immunity in influenza infection by inhibiting activation of NLRP3 inflammasome and expression of interferon-β. Mol Immunol, 125:178-86.
34. Woodby B, Arnold MM, Valacchi G (2021). SARS‐CoV‐2 infection, COVID‐19 pathogenesis, and exposure to air pollution: What is the connection? Ann N Y Acad Sci, 1486(1):15-38.
35. Meng Y, Lu Y, Xiang H, Liu S (2021). Short-term effects of ambient air pollution on the incidence of influenza in Wuhan, China: a time-series analysis. Environ Res, 192:110327.
36. Ciencewicki J, Jaspers I (2007). Air pollution and respiratory viral infection. Inhal Toxicol, 19(14):1135-46.
37. Pannullo F, Lee D, Neal L, et al (2017). Quantifying the impact of current and future concentrations of air pollutants on respiratory disease risk in England. Environ Health, 16:29.
38. Hadler JL, Yousey-Hindes K, Pérez A, et al (2016). Influenza-related hospitalizations and poverty levels—United States, 2010–2012. MMWR Morb Mortal Wkly Rep, 65(5):101-5.
39. Jama (2016). Influenza Hits Poor People Hardest. Available from: https://jamanetwork.com/journals/jama/article-abstract/2504824
40. Vamos S, Okan O, Sentell T, Rootman I (2020). Making a case for “Education for health literacy”: An international perspective. Int J Environ Res Public Health, 17(4):1436.
41. Castro-Sánchez E, Chang PW, Vila-Candel R, et al (2016). Health literacy and infectious diseases: why does it matter? Int J Infect Dis, 43:103-110.
42. Wang M, Han X, Fang H, et al (2018). Impact of health education on knowledge and behaviors toward infectious diseases among students in Gansu Province, China. Biomed Res Int, 2018:6397340.
43. Biswas D, Ahmed M, Roguski K, et al (2019). Effectiveness of a behavior change intervention with hand sanitizer use and respiratory hygiene in reducing laboratory-confirmed influenza among schoolchildren in Bangladesh: a cluster randomized controlled trial. Am J Trop Med Hyg, 101(6):1446-1455.
44. Or PP-L, Ching PT-Y, Chung JW-Y (2020). Can flu-like absenteeism in kindergartens be reduced through hand hygiene training for both parents and their kindergarteners? J Prim Care Community Health, 11:2150132719901209.
45. Spicknall IH, Koopman JS, Nicas M, et al (2010). Informing optimal environmental influenza interventions: how the host, agent, and environment alter dominant routes of transmission. PLoS Comput Biol, 6(10):e1000969.
46. Garrett TA (2008). Economic effects of the 1918 influenza pandemic. Fed Reserve Bank ST Louis, 26:74-94.
47. Ohadike DC (1991). Diffusion and physiological responses to the influenza pandemic of 1918–19 in Nigeria. Soc Sci Med, 32(12):1393-9.
48. Kao CL, Chan TC, Tsai CH, et al (2012). Emerged HA and NA mutants of the pandemic influenza H1N1 viruses with increasing epidemiological significance in Taipei and Kaohsiung, Taiwan, 2009–10. PLoS One, 7(2):e31162.
2. Fry I (2022). Climate change the greatest threat the world has ever faced, UN expert warns. United Nations; https://www.ohchr.org/en/press-releases/2022/10/climate-change-greatest-threat-world-has-ever-faced-un-expert-warns
3. Regan MS (2024). Health and Environmental Effects of Particulate Matter (PM). United States Environmental Protection Agency; https://www.epa.gov/pm-pollution/health-and-environmental-effects-particulate-matter-pm
4. Regan MS (2024). Particulate Matter (PM) Basics. United States Environmental Protection Agency; https://www.epa.gov/pm-pollution/particulate-matter-pm-basics
5. Basith S, Manavalan B, Shin TH, et al (2022). The impact of fine particulate matter 2.5 on the cardiovascular system: a review of the invisible killer. Nanomaterials (Basel), 12(15):2656.
6. Anwar A, Ullah I, Younis M, Flahault A (2021). Impact of air pollution (PM2. 5) on child mortality: Evidence from sixteen Asian countries. Int J Environ Res Public Health, 18(12):6375.
7. Manisalidis I, Stavropoulou E, Stavropoulos A, et al (2020). Environmental and health impacts of air pollution: a review. Front Public Health, 8:14.
8. Lavigne E, Burnett RT, Stieb DM, et al (2018). Fine particulate air pollution and adverse birth outcomes: effect modification by regional nonvolatile oxidative potential. Environ Health Perspect, 126(07):077012.
9. Zhang X, Fan C, Ren Z, et al (2020). Maternal PM 2.5 exposure triggers preterm birth: a cross-sectional study in Wuhan, China. Glob Health Res Policy, 5:17.
10. Loaiza-Ceballos MC, Marin-Palma D, Zapata W, et al (2022). Viral respiratory infections and air pollutants. Air Qual Atmos Health, 15(1):105-14.
11. Wang X, Cai J, Liu X, et al (2023). Impact of PM2. 5 and ozone on incidence of influenza in Shijiazhuang, China: a time-series study. Environ Sci Pollut Res, 30(4):10426-43.
12. World Health Organization (2023). Influenza (Seasonal). Available From: https://www.who.int/news-room/fact-sheets/detail/influenza-(seasonal)
13. Yang J, Yang Z, Qi L, et al (2023). Influence of air pollution on influenza-like illness in China: a nationwide time-series analysis. EBioMedicine, 87: 104421.
14. Qi L, Gao Y, Yang J, et al (2020). The burden of influenza and pneumonia mortality attributable to absolute humidity among elderly people in Chongqing, China, 2012–2018. Sci Total Environ, 716:136682.
15. Guerrisi C, Ecollan M, Souty C, et al (2019). Factors associated with influenza-like-illness: a crowdsourced cohort study from 2012/13 to 2017/18. BMC Public Health, 19:879.
16. Matsuki E, Kawamoto S, Morikawa Y, et al (2023). The impact of cold ambient temperature in the pattern of influenza virus infection. Open Forum Infect Dis, 10(2): ofad039.
17. Sun R, Tao J, Tang N, et al (2024). Air Pollution and Influenza: A Systematic Review and Meta-Analysis. Iran J Public Health, 53(1):1-11.
18. Liu XX, Li Y, Qin G, et al (2019). Effects of air pollutants on occurrences of influenza-like illness and laboratory-confirmed influenza in Hefei, China. Int J Biometeorol, 63:51-60.
19. Carlier FM, de Fays C, Pilette C (2021). Epithelial barrier dysfunction in chronic respiratory diseases. Front Physiol, 12:691227.
20. Lee PH, Park S, Lee YG, et al (2021). The impact of environmental pollutants on barrier dysfunction in respiratory disease. Allergy Asthma Immunol Res, 13(6):850-862.
21. Xu Z, Hu W, Williams G, et al (2013). Air pollution, temperature and pediatric influenza in Brisbane, Australia. Environ Int, 59:384-8.
22. Amuakwa-Mensah F, Marbuah G, Mubanga M (2017). Climate variability and infectious diseases nexus: Evidence from Sweden. Infect Dis Model, 2(2):203-17.
23. Gujrati D. Basic Econometrics: Hoboken: Prentice Hall; 2022.
24. Roodman D (2009). How to do xtabond2: An introduction to difference and system GMM in Stata. Stata J, 9(1):86-136.
25. Croft DP, Zhang W, Lin S, et al (2020). Associations between source-specific particulate matter and respiratory infections in New York state adults. Environ Sci Technol, 54(2):975-84.
26. Chen Y, Hou W, Hou W, et al (2023). Lagging effects and prediction of pollutants and their interaction modifiers on influenza in northeastern China. BMC Public Health, 23(1):1826.
27. Rohde RA, Muller RA (2015). Air pollution in China: mapping of concentrations and sources. PLoS One, 10(8):e0135749.
28. Bălă G-P, Râjnoveanu R-M, Tudorache E, et al (2021). Air pollution exposure—the (in) visible risk factor for respiratory diseases. Environ Sci Pollut Res, 28(16):19615-28.
29. Zhou Z, Shuai X, Lin Z, et al (2023). Association between particulate matter (PM) 2· 5 air pollution and clinical antibiotic resistance: a global analysis. Lancet Planet Health, 7(8):e649-e59.
30. Schlesinger RB (2007). The health impact of common inorganic components of fine particulate matter (PM2. 5) in ambient air: a critical review. Inhal Toxicol, 19(10):811-32.
31. Chen G, Zhang W, Li S, et al (2017). The impact of ambient fine particles on influenza transmission and the modification effects of temperature in China: a multi-city study. Environ Int, 98:82-8.
32. Toczylowski K, Wietlicka-Piszcz M, Grabowska M, et al (2021). Cumulative effects of particulate matter pollution and meteorological variables on the risk of influenza-like illness. Viruses, 13(4):556.
33. Tao RJ, Cao WJ, Li MH, et al (2020). PM2. 5 compromises antiviral immunity in influenza infection by inhibiting activation of NLRP3 inflammasome and expression of interferon-β. Mol Immunol, 125:178-86.
34. Woodby B, Arnold MM, Valacchi G (2021). SARS‐CoV‐2 infection, COVID‐19 pathogenesis, and exposure to air pollution: What is the connection? Ann N Y Acad Sci, 1486(1):15-38.
35. Meng Y, Lu Y, Xiang H, Liu S (2021). Short-term effects of ambient air pollution on the incidence of influenza in Wuhan, China: a time-series analysis. Environ Res, 192:110327.
36. Ciencewicki J, Jaspers I (2007). Air pollution and respiratory viral infection. Inhal Toxicol, 19(14):1135-46.
37. Pannullo F, Lee D, Neal L, et al (2017). Quantifying the impact of current and future concentrations of air pollutants on respiratory disease risk in England. Environ Health, 16:29.
38. Hadler JL, Yousey-Hindes K, Pérez A, et al (2016). Influenza-related hospitalizations and poverty levels—United States, 2010–2012. MMWR Morb Mortal Wkly Rep, 65(5):101-5.
39. Jama (2016). Influenza Hits Poor People Hardest. Available from: https://jamanetwork.com/journals/jama/article-abstract/2504824
40. Vamos S, Okan O, Sentell T, Rootman I (2020). Making a case for “Education for health literacy”: An international perspective. Int J Environ Res Public Health, 17(4):1436.
41. Castro-Sánchez E, Chang PW, Vila-Candel R, et al (2016). Health literacy and infectious diseases: why does it matter? Int J Infect Dis, 43:103-110.
42. Wang M, Han X, Fang H, et al (2018). Impact of health education on knowledge and behaviors toward infectious diseases among students in Gansu Province, China. Biomed Res Int, 2018:6397340.
43. Biswas D, Ahmed M, Roguski K, et al (2019). Effectiveness of a behavior change intervention with hand sanitizer use and respiratory hygiene in reducing laboratory-confirmed influenza among schoolchildren in Bangladesh: a cluster randomized controlled trial. Am J Trop Med Hyg, 101(6):1446-1455.
44. Or PP-L, Ching PT-Y, Chung JW-Y (2020). Can flu-like absenteeism in kindergartens be reduced through hand hygiene training for both parents and their kindergarteners? J Prim Care Community Health, 11:2150132719901209.
45. Spicknall IH, Koopman JS, Nicas M, et al (2010). Informing optimal environmental influenza interventions: how the host, agent, and environment alter dominant routes of transmission. PLoS Comput Biol, 6(10):e1000969.
46. Garrett TA (2008). Economic effects of the 1918 influenza pandemic. Fed Reserve Bank ST Louis, 26:74-94.
47. Ohadike DC (1991). Diffusion and physiological responses to the influenza pandemic of 1918–19 in Nigeria. Soc Sci Med, 32(12):1393-9.
48. Kao CL, Chan TC, Tsai CH, et al (2012). Emerged HA and NA mutants of the pandemic influenza H1N1 viruses with increasing epidemiological significance in Taipei and Kaohsiung, Taiwan, 2009–10. PLoS One, 7(2):e31162.
| Files | ||
| Issue | Vol 54 No 1 (2025) | |
| Section | Original Article(s) | |
| Keywords | ||
| Air pollution Influenza Population density Generalized method of moments GMM Polluted countries | ||
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How to Cite
1.
Anwar A, Hyder S, Khan N, Ayub M, Yucel R, Younis M. Air Pollution and Influenza Incidence: Evidence from Highly Polluted Countries. Iran J Public Health. 2025;54(1):186-194.
