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.
Highlights
The findings revealed that the analysis based on excess all-cause mortality reduced the potential impact of NO2 and PM2.5 emissions and enhanced the influence of visits to parks and workplaces, as compared with the estimation based on movement restrictions significantly decreased NO2 emissions, a positive association was still observed in NO2 related to excess mortality
The results showed that COVID-19 dramatically increased death counts compared with benchmark mortality trends, leading to high rates of excess all-cause mortality
For the impacts of air pollution and human activity, an increase of 1.54% and decreases of 0.19%, 0.23%, and 0.23% in excess all-cause mortality rates were revealed with a 1-unit increase of weekly NO2, PM2.5, park visits, and workplace visits, respectively
Summary
Coronavirus Disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was first identified in December 2019, and has caused. 2,695,004 deaths worldwide as of 18 March 2021. Countries around the world proposed many policies to mitigate the spread of the disease, including lockdowns and the restriction of human mobility [1,2]. The lockdown policies themselves may have triggered other health issues. Research revealed that the restriction of social contact can cause severe mental health issues [3,4,5] and physical problems such as obesity [6].
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