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Environ Health ; 20(1): 101, 2021 09 06.
Artigo em Inglês | MEDLINE | ID: mdl-34488764


BACKGROUND: The outbreak of coronavirus disease (COVID-19) began in Wuhan, China in December 2019 and was declared a global pandemic on 11 March 2020. This study aimed to assess the effects of temperature and long-term exposure to air pollution on the COVID-19 mortality rate at the sub-national level in France. METHODS: This cross-sectional study considered different periods of the COVID-19 pandemic from May to December 2020. It included 96 departments (or NUTS 3) in mainland France. Data on long-term exposure to particulate matter (PM2.5), annual mean temperature, health services, health risk, and socio-spatial factors were used as covariates in negative binomial regression analysis to assess their influence on the COVID-19 mortality rate. All data were obtained from open-access sources. RESULTS: The cumulative COVID-19 mortality rate by department increased during the study period in metropolitan France-from 19.8/100,000 inhabitants (standard deviation (SD): 20.1) on 1 May 2020, to 65.4/100,000 inhabitants (SD: 39.4) on 31 December 2020. The rate was the highest in the departments where the annual average of long-term exposure to PM2.5 was high. The negative binomial regression models showed that a 1 µg/m3 increase in the annual average PM2.5 concentration was associated with a statistically significant increase in the COVID-19 mortality rate, corresponding to 24.4%, 25.8%, 26.4%, 26.7%, 27.1%, 25.8%, and 15.1% in May, June, July, August, September, October, and November, respectively. This association was no longer significant on 1 and 31 December 2020. The association between temperature and the COVID-19 mortality rate was only significant on 1 November, 1 December, and 31 December 2020. An increase of 1 °C in the average temperature was associated with a decrease in the COVID-19-mortality rate, corresponding to 9.7%, 13.3%, and 14.5% on 1 November, 1 December, and 31 December 2020, respectively. CONCLUSION: This study found significant associations between the COVID-19 mortality rate and long-term exposure to air pollution and temperature. However, these associations tended to decrease with the persistence of the pandemic and massive spread of the disease across the entire country.

Poluentes Atmosféricos/efeitos adversos , COVID-19/mortalidade , Exposição Ambiental/efeitos adversos , Material Particulado/efeitos adversos , Estudos Transversais , Exposição Ambiental/estatística & dados numéricos , França/epidemiologia , Humanos , Modelos Estatísticos , SARS-CoV-2 , Temperatura
PLoS One ; 16(9): e0256857, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34534226


BACKGROUND: The 2019 coronavirus (COVID-19) epidemic began in Wuhan, China in December 2019 and quickly spread to the rest of the world. This study aimed to analyse the associations between the COVID-19 mortality rate in hospitals, the availability of health services, and socio-spatial and health risk factors at department level. METHODS AND FINDINGS: This spatial cross-sectional study used cumulative mortality data due to the COVID-19 pandemic in hospitals until 30 November 2020 as a main outcome, across 96 departments of mainland France. Data concerning health services, health risk factors, and socio-spatial factors were used as independent variables. Independently, we performed negative binomial, spatial and geographically weighted regression models. Our results revealed substantial geographic disparities. The spatial exploratory analysis showed a global positive spatial autocorrelation in each wave indicating a spatial dependence of the COVID-19 deaths across departments. In first wave about 75% of COVID-19 deaths were concentrated in departments of five regions compared to a total of 13 regions. The COVID-19 mortality rate was associated with the physicians density, and not the number of resuscitation beds. Socio-spatial factors were only associated with the COVID-19 mortality rate in first wave compared to wave 2. For example, the COVID-19 mortality rate increased by 35.69% for departments densely populated. Health risk factors were associated with the COVID-19 mortality rate depending on each wave. This study had inherent limitations to the ecological analysis as ecological bias risks and lack of individual data. CONCLUSIONS: Our results suggest that the COVID-19 pandemic has spread more rapidly and takes more severe forms in environments where there is already a high level of vulnerability due to social and health factors. This study showed a different dissemination pattern of COVID-19 mortality between the two waves: a spatial non-stationarity followed by a spatial stationarity in the relationships between the COVID-19 mortality rate and its potential drivers.

COVID-19/mortalidade , Pandemias , Idoso , Estudos Transversais , Feminino , França/epidemiologia , Acesso aos Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Análise Espacial