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Title: Assessing the country-level excess all-cause mortality and the impacts of air pollution and human activity during the COVID-19 epidemic
Authors: Meng, Y 
Wong, MS 
Xing, H
Kwan, MP
Zhu, R 
Issue Date: Jul-2021
Source: International journal of environmental research and public health, July 2021, v. 18, no. 13, 6883
Abstract: The impact of Coronavirus Disease 2019 (COVID-19) on cause-specific mortality has been investigated on a global scale. However, less is known about the excess all-cause mortality and air pollution-human activity responses. This study estimated the weekly excess all-cause mortality during COVID-19 and evaluated the impacts of air pollution and human activities on mortality variations during the 10th to 52nd weeks of 2020 among sixteen countries. A SARIMA model was adopted to estimate the mortality benchmark based on short-term mortality during 2015–2019 and calculate excess mortality. A quasi-likelihood Poisson-based GAM model was further applied for air pollution/human activity response evaluation, namely ground-level NO2 and PM2.5 and the visit frequencies of parks and workplaces. The findings showed that, compared with COVID-19 mortality (i.e., cause-specific mortality), excess all-cause mortality changed from −26.52% to 373.60% during the 10th to 52nd weeks across the sixteen countries examined, revealing higher excess all-cause mortality than COVID-19 mortality in most countries. For the impact of air pollution and human activities, the average country-level relative risk showed that one unit increase in weekly NO2, PM2.5, park visits and workplace visits was associated with approximately 1.54% increase and 0.19%, 0.23%, and 0.23% decrease in excess all-cause mortality, respectively. Moreover, compared with the impact on COVID-19 mortality, the relative risks of weekly NO2 and PM2.5 were lower, and the relative risks of weekly park and workplace visits were higher for excess all-cause mortality. These results suggest that the estimation based on excess all-cause mortality reduced the potential impact of air pollution and enhanced the influence of human activities compared with the estimation based on COVID-19 mortality.
Keywords: Air pollution
COVID-19 mortality
Excess mortality
Human activities
Publisher: Molecular Diversity Preservation International (MDPI)
Journal: International journal of environmental research and public health 
ISSN: 1661-7827
EISSN: 1660-4601
DOI: 10.3390/ijerph18136883
Rights: © 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// 4.0/)
The following publication Meng, Y.; Wong, M.S.; Xing, H.; Kwan, M.-P.; Zhu, R. Assessing the Country-Level Excess All-Cause Mortality and the Impacts of Air Pollution and Human Activity during the COVID-19 Epidemic. Int. J. Environ. Res. Public Health 2021, 18, 6883 is available at
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