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      COVID-19 incidence and mortality in Lombardy, Italy: an ecological study on the role of air pollution, meteorological factors, demographic and socioeconomic variables

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          Abstract

          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 2) 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 1,439 municipalities out of 1,507 (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 20 th to April 16 th and from March 1 st to April 30 th, 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 3 in the mean annual concentrations of PM2.5 and PM10 over the previous years was associated with a 58% and 34% increase in COVID-19 incidence rate, respectively. Similarly, a 10 μg/m 3 increase of annual mean PM2.5 concentration was associated with a 23% increase in all-cause mortality. An inverse association was found between NO 2 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.

          Highlights

          • Lombardy is an industrialized region with one of the worst air quality in Europe.

          • Lombardy was the epicentre of the first wave of COVID-19 pandemic in Italy.

          • Long-term exposure to PM was associated with COVID-19 incidence and mortality.

          • Meteorological variables were associated with COVID-19 incidence and mortality.

          • Socioeconomic variables were associated with COVID-19 incidence and mortality.

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          Fitting Linear Mixed-Effects Models Usinglme4

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            Baseline Characteristics and Outcomes of 1591 Patients Infected With SARS-CoV-2 Admitted to ICUs of the Lombardy Region, Italy

            In December 2019, a novel coronavirus (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]) emerged in China and has spread globally, creating a pandemic. Information about the clinical characteristics of infected patients who require intensive care is limited.
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              A general and simple method for obtainingR2from generalized linear mixed-effects models

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                Author and article information

                Journal
                Environ Res
                Environ Res
                Environmental Research
                The Author(s). Published by Elsevier Inc.
                0013-9351
                1096-0953
                22 January 2021
                22 January 2021
                Affiliations
                [1 ]Department of Information Engineering, University of Brescia, Via Branze 38, 25123, Brescia, Italy
                [2 ]Department of Molecular and Translational Medicine, University of Brescia, Viale Europa 11, 25123, Brescia, Italy
                [3 ]Department of Mechanical and Industrial Engineering, University of Brescia, Via Branze 38, 25123, Brescia, Italy
                [4 ]B+LabNet - Environmental Sustainability Lab, University of Brescia, Via Branze 45, 25123, Brescia, Italy
                [5 ]Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Unit of Hygiene, Epidemiology, and Public Health, University of Brescia, Viale Europa 11, 25123, Brescia, Italy
                [6 ]Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 17177, Stockholm, Sweden
                [7 ]School of Public Health, Florida International University, Miami, Florida, USA
                Author notes
                []Corresponding author. Department of Medical and Surgical Specialties, Radiological Science and Public Health University of Brescia, Brescia, Italy, Viale Europa 11 – 25123 Brescia, Italy,
                [†]

                These authors contributed equally: Elena de Angelis and Stefano Renzetti.

                Article
                S0013-9351(21)00071-2 110777
                10.1016/j.envres.2021.110777
                7826113
                33485909
                b8cfb24c-b5cb-4d9e-895c-a7c074e992ef
                © 2021 The Author(s)

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

                Categories
                Article

                General environmental science
                covid-19,ecological study,excess mortality,incidence,risk factors
                General environmental science
                covid-19, ecological study, excess mortality, incidence, risk factors

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