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

Miryoung Yoon, Jong-Hun Kim, Jisun Sung, Ah-Young Lim, Myung-Jae Hwang, Eun-Hye Kim and Hae-Kwan Cheong
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Miryoung Yoon: Department of Social and Preventive Medicine, Sungkyunkwan University School of Medicine, Suwon 16419, Korea
Jong-Hun Kim: Department of Social and Preventive Medicine, Sungkyunkwan University School of Medicine, Suwon 16419, Korea
Jisun Sung: Department of Social and Preventive Medicine, Sungkyunkwan University School of Medicine, Suwon 16419, Korea
Ah-Young Lim: Department of Social and Preventive Medicine, Sungkyunkwan University School of Medicine, Suwon 16419, Korea
Myung-Jae Hwang: Department of Social and Preventive Medicine, Sungkyunkwan University School of Medicine, Suwon 16419, Korea
Eun-Hye Kim: Department of Social and Preventive Medicine, Sungkyunkwan University School of Medicine, Suwon 16419, Korea
Hae-Kwan Cheong: Department of Social and Preventive Medicine, Sungkyunkwan University School of Medicine, Suwon 16419, Korea

IJERPH, 2021, vol. 18, issue 5, 1-12

Abstract: 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 2.5 ) and nitrogen dioxide (NO 2 ) levels increased by one unit of air quality index (AQI), the infection risk decreased by 0.7% and 3.4%, respectively. When PM 2.5 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 2.5 and NO 2 levels increased by one AQI, relative risk for PM 2.5 and NO 2 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.

Keywords: environmental epidemiology; air pollution; health behavior; personal protective equipment; mask-wearing (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2021
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