The Relation of Air Pollution on Morbidity and Mortality of SARS CoV 2 Infection in Tekirdag, Türkiye
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Abstract
Background: We aimed to investigate the relation between environmental air pollutants such as Particulate Matter 10 (PM10), Particulate Matter 2.5 (PM2.5), Sulfur Dioxide (SO2) on daily cases and deaths associated with SARS-CoV-2 infection.
Methods: The ecological research examined the correlations of the air quality metrics and the data of COVID-19 cases and deaths from March 1, 2020 to March 1, 2021 in the central District of Tekirdağ Province in Türkiye.
Results: During the study period, the average PM10 concentration was 32.57±17.86 µg/m3, PM2.5 was 20.68±11.31 µg/m3, SO2 was 11.28±13.42 µg/m3, and NO2 was 19.07±7.26 µg/m3. The SARS-CoV-2 case fatality rate in the study area during this period was 3.2%. Correlation analyses between air pollutants and SARS-CoV-2 cases and deaths revealed significant positive associations between SARS-CoV-2 cases (r=0.220 for PM10, P<0.001; r=0.290 for PM2.5, P<0.001; r=0.218 for SO2, P<0.001) and deaths (r=0.203 for PM10, P<0.001; r=0.289 for PM2.5, P<0.001; r=0.278 for SO2, P<0.001). Moreover, regression analysis revealed that ambient sulfur dioxide (SO₂) levels significantly predicted both COVID-19 incidence and mortality.
Conclusion: PM10, PM2.5, and SO2, key parameters for assessing air quality, exhibit a positive relationship with the increasing number of daily SARS-CoV-2 cases and daily deaths in the study area.
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16. Gandini M, Scarinzi C, Bande Se, et al (2018). Long term effect of air pollution on incident hospital admissions: Results from the Italian Longitudinal Study within LIFE MED HISS project. Environ Int, 121:1087–1097.
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21. Yekdeş DH, Yekdeş AC, Çelikkalp Ü, et al (2023). Chronic obstructive pulmonary disease and lung cancer mortality at-tributed to air pollution in Türkiye in 2019. Aerosol and Air Quality Research, 23(10): 2023.
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24. Ab Manan NA, Aizuddin AN, Hod R (2018). Effect of air pollution and hospi-tal admission: a systematic review. Ann Glob Health, 84(4): 670–678.
25. Li J, Sun S, Tang R, et al (2016). Major air pollutants and risk of COPD exacerba-tions: a systematic review and meta-analysis. Int J Chron Obstruct Pulmon Dis, 11: 3079–3091.
26. Kara Rapor 2021. https://www.temizhavahakki.com/kararapor2021/ Accessed 25 September, 2022
27. Yılmaz V, Şimşek T (2020). The Relation-ship Between Air Quality and COVID-19: An Application on G-7 Countries. Journal of Turkish Studies, 15(4): 1353-1366.
28. Adhikari A, Yin J (2020). Short-Term effects of ambient ozone, pm2.5, and meteoro-logical factors on COVID-19 confirmed cases and deaths in queens, New York. Int J Environ Res Public Health, 17(11):4047.
29. Setti L, Passarini F, De Gennaro G, et al (2020). SARS-Cov-2RNA found on par-ticulate matter of Bergamo in Northern Italy: First evidence. Environ Res, 188:109754.
30. Travaglio M, Yu Y, Popovic R, et al (2021). Links between air pollution and COVID-19 in England. Environ Pollut, 268:115859.
31. Saez M, Tobias A, Barceló MA (2020). Ef-fects of long-term exposure to air pollu-tants on the spatial spread of COVID-19 in Catalonia, Spain. Environ Res, 191: 110177.
32. Varol G, Tokuç B, Ozkaya S, Çağlayan, Ç (2021). Air quality and preventable deaths in Tekirdağ, Turkey. Air Qual At-mos Health, 14(6):843-853.
33. Wu X, Nethery RC, Sabath MB, et al (2020). Exposure to air pollution and COVID-19 mortality in the United States. Sci Adv, 6(45): eabd4049.
34. Meo SA, Abukhalaf AA, Sami W, Hoang TD (2021). Effect of environmental pol-lution PM2.5, carbon monoxide, and ozone on the incidence and mortality due to SARS-CoV-2 infection in London, United Kingdom. J King Saud Univ Sci, 33(3):101373.
35. Comunian S, Dongo D, Milani C, Palestini P (2020). Air pollution and COVID-19: the role of particulate matter in the spread and increase of COVID-19’s morbidity and mortality. Int J Environ Res Public Health, 17(12): 4487.
36. Gouveia N, Kephart JL, Dranova I, et al (2021). Ambient fine particulate matter in Latin American cities: Levels, popula-tion exposure, and associated urban fac-tors. Sci Total Environ, 772: 145035.
37. DeViries R, Kriebel D, Sama S (2017). Out-door air pollution and COPDrelated emergency department visits, hospital admissions, and mortality: a meta-analysis. COPD, 14(1):113– 121.
38. Bostan P, Olcay SS (2022). Dünden Bugüne Ülkemizde Yapılan Dış Ortam Hava-kirliliği Sağlık Etkileri Araştırmaları. Tü-rkiye Sağlık Araştırmaları Dergisi, 3(3): 22-29.
39. Faridi S, Yousefian F, Niazi S, et al (2020). Impact of SARS-CoV-2 on ambient air particulate matter Tehran. Aerosol Air Qual Res, 20(8): 1805–1811.
40. Mahmou A S, Shams MY, Hassanien AE (2021). COVID-19 Outbreak and ıts ef-fect on global environment sustainable system: recommendation and future challenges. theglobal environmental ef-fects during and beyond COVID-19. In-telligent Computing Solutions, 163- 177.
41. Ulusoy K (2024). Zonguldak’ta PM2.5 odaklı hava kirliliği-mortalite ilişkisinin incelenmesi., NOHU J Eng Sci, 13(1):301-308.
2. Covid-19 Coronavirus Pandemic. https://www.worldometers.info/coronavirus/ Accessed 02 March, 2024.
3. Wadhera, RK, Shen C, Gondi S, et al (2021). Cardiovascular deaths during the COVID-19 pandemic in the United States. J Am Coll Cardiol, 77(2):159-169.
4. Conticini E, Frediani B, Caro D (2020). Can atmospheric pollution be considered a co-factor in extremely high level of SARS-CoV-2 lethality in Northern Italy? Environ Pollut, 261:114465.
5. Cole MA, Ozgen C, Strobl E (2020). Air pol-lution exposure and Covid-19 in Dutch municipalities. Environ Resour Econ (Dordr), 76(4):581-610.
6. Frontera A, Cianfanelli L, Vlachos K, et al (2020). Landoni G, Cremona G. Severe air pollution links to higher mortality in COVID-19 patients: The "double hit" hypothesis. J Infect, 81(2):255-259.
7. Zhu Y, Xie J, Huang F, Cao L (2020). Asso-ciation between short-term exposure to air pollution and COVID-19 infection: evidence from China. Sci Total Environ, 727: 138704.
8. Pozzer A, Dominici F, Haines A, et al (2020). Regional and global contribu-tions of air pollution to risk of death from COVID-19. Cardiovasc Res, 116(14): 2247-2253.
9. Domingo JL, Rovira J (2020). Effects of air pollutants on the transmission and se-verity of respiratory viral infections. En-viron Res, 187:109650.
10. Coker ES, Cavalli L, Fabrizi E. et al (2020). The effects of air pollution on COVID-19 related mortality in northern Italy. Environ Resour Econ (Dordr), 76(4):611-634.
11. Marquès M, Domingo JL (2022). Positive as-sociation between outdoor air pollution and the incidence and severity of COVID-19. A review of the recent scien-tific evidences. Environ Res, 203: 111930.
12. Turkish Statistical Institute (TUİK) 2022. https://data.tuik.gov.tr/Bulten/Index?p=Il- Bazinda-Gayrisafi-Yurt-Ici-Hasila-2019-33663 Accessed 20 September, 2022.
13. Republic of Turkey Tekirdag Governor-ship (RTKG) (2018). Environmental sta-tus report for Tekirdag 2017. Accessed 20 September, 2022.
14. Republic of Turkey Tekirdag Governor-ship (RTKG) (2019). Environmental sta-tus report for Tekirdag 2018. Accessed 20 September, 2022.
15. Cannon JB, Lefler JS, Blagev DP, et al (2018). Short-term elevation of fine par-ticulate matter air pollution and acute lower respiratory infection. Am J Respir Crit Care Med, 198:759–766.
16. Gandini M, Scarinzi C, Bande Se, et al (2018). Long term effect of air pollution on incident hospital admissions: Results from the Italian Longitudinal Study within LIFE MED HISS project. Environ Int, 121:1087–1097.
17. Bhuiyan MA, Galdes, N, Cuschieri, S. et al (2024). A comparative systematic review of risk factors, prevalence, and chal-lenges contributing to non-communicable diseases in South Asia, Africa, and Caribbeans. J Health Popul Nutr, 43:140.
18. Begou P, Kassomenos, P (2022). Burden of natural-cause and cause-specific mortali-ty associated with long-term exposure to PM2. 5: A case study in Attica Region, Greece. Atmosphere, 13(12):2026.
19. Pope CA, 3rd, J.S. Lefler, M. Ezzati, et al (2019). Mortality risk and fine particulate air pollution in a large, representative cohort of U.S. Adults. Environ Health Per-spect, 127: 77007.
20. Chen X, Zhang LW, Huang JJ, et al (2016). Long-term exposure to urban air pollu-tion and lung cancer mortality: a 12-year cohort study in Northern China. Sci To-tal Environ, 571: 855- 861.
21. Yekdeş DH, Yekdeş AC, Çelikkalp Ü, et al (2023). Chronic obstructive pulmonary disease and lung cancer mortality at-tributed to air pollution in Türkiye in 2019. Aerosol and Air Quality Research, 23(10): 2023.
22. Khosravipour M, Safari-Faramani, R, Rajati, F, Omidi, F (2022). The long-term effect of exposure to respirable particulate matter on the incidence of myocardial infarction: A systematic review and me-ta-analysis study. Environ Sci Pollut Res Int, 29: 42347–42371.
23. Beelen R, Raaschou-Nielsen O, (2014). Ef-fects of long-term exposure to air pollu-tion on natural-cause mortality: an anal-ysis of 22 European cohorts within the multicentre ESCAPE project. Lancet, 383(9919):785-795.
24. Ab Manan NA, Aizuddin AN, Hod R (2018). Effect of air pollution and hospi-tal admission: a systematic review. Ann Glob Health, 84(4): 670–678.
25. Li J, Sun S, Tang R, et al (2016). Major air pollutants and risk of COPD exacerba-tions: a systematic review and meta-analysis. Int J Chron Obstruct Pulmon Dis, 11: 3079–3091.
26. Kara Rapor 2021. https://www.temizhavahakki.com/kararapor2021/ Accessed 25 September, 2022
27. Yılmaz V, Şimşek T (2020). The Relation-ship Between Air Quality and COVID-19: An Application on G-7 Countries. Journal of Turkish Studies, 15(4): 1353-1366.
28. Adhikari A, Yin J (2020). Short-Term effects of ambient ozone, pm2.5, and meteoro-logical factors on COVID-19 confirmed cases and deaths in queens, New York. Int J Environ Res Public Health, 17(11):4047.
29. Setti L, Passarini F, De Gennaro G, et al (2020). SARS-Cov-2RNA found on par-ticulate matter of Bergamo in Northern Italy: First evidence. Environ Res, 188:109754.
30. Travaglio M, Yu Y, Popovic R, et al (2021). Links between air pollution and COVID-19 in England. Environ Pollut, 268:115859.
31. Saez M, Tobias A, Barceló MA (2020). Ef-fects of long-term exposure to air pollu-tants on the spatial spread of COVID-19 in Catalonia, Spain. Environ Res, 191: 110177.
32. Varol G, Tokuç B, Ozkaya S, Çağlayan, Ç (2021). Air quality and preventable deaths in Tekirdağ, Turkey. Air Qual At-mos Health, 14(6):843-853.
33. Wu X, Nethery RC, Sabath MB, et al (2020). Exposure to air pollution and COVID-19 mortality in the United States. Sci Adv, 6(45): eabd4049.
34. Meo SA, Abukhalaf AA, Sami W, Hoang TD (2021). Effect of environmental pol-lution PM2.5, carbon monoxide, and ozone on the incidence and mortality due to SARS-CoV-2 infection in London, United Kingdom. J King Saud Univ Sci, 33(3):101373.
35. Comunian S, Dongo D, Milani C, Palestini P (2020). Air pollution and COVID-19: the role of particulate matter in the spread and increase of COVID-19’s morbidity and mortality. Int J Environ Res Public Health, 17(12): 4487.
36. Gouveia N, Kephart JL, Dranova I, et al (2021). Ambient fine particulate matter in Latin American cities: Levels, popula-tion exposure, and associated urban fac-tors. Sci Total Environ, 772: 145035.
37. DeViries R, Kriebel D, Sama S (2017). Out-door air pollution and COPDrelated emergency department visits, hospital admissions, and mortality: a meta-analysis. COPD, 14(1):113– 121.
38. Bostan P, Olcay SS (2022). Dünden Bugüne Ülkemizde Yapılan Dış Ortam Hava-kirliliği Sağlık Etkileri Araştırmaları. Tü-rkiye Sağlık Araştırmaları Dergisi, 3(3): 22-29.
39. Faridi S, Yousefian F, Niazi S, et al (2020). Impact of SARS-CoV-2 on ambient air particulate matter Tehran. Aerosol Air Qual Res, 20(8): 1805–1811.
40. Mahmou A S, Shams MY, Hassanien AE (2021). COVID-19 Outbreak and ıts ef-fect on global environment sustainable system: recommendation and future challenges. theglobal environmental ef-fects during and beyond COVID-19. In-telligent Computing Solutions, 163- 177.
41. Ulusoy K (2024). Zonguldak’ta PM2.5 odaklı hava kirliliği-mortalite ilişkisinin incelenmesi., NOHU J Eng Sci, 13(1):301-308.
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| Issue | Vol 54 No 11 (2025) | |
| Section | Original Article(s) | |
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| Covıd-19 SARS-CoV-2 Air pollution Mortality | ||
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How to Cite
1.
Varol G, Tokuç B, Çelikkalp Ülfiye, Etiler N. The Relation of Air Pollution on Morbidity and Mortality of SARS CoV 2 Infection in Tekirdag, Türkiye. Iran J Public Health. 2025;54(11):2463-2472.
