Long-term exposure to air pollution and COVID-19 incidence: A multi-country study

The study of the impacts of air pollution on COVID-19 has gained increasing attention. However, most of the existing studies are based on a single country, with a high degree of variation in the results reported in different papers. We attempt to inform the debate about the long-term effects of air pollution on COVID-19 by conducting a multi-country analysis using a spatial ecological design, including Canada, Italy, England and the United States. The model allows the residual spatial autocorrelation after accounting for covariates. It is concluded that the effects of PM2.5 and NO2 are inconsistent across countries. Specifically, NO2 was not found to be an important factor affecting COVID-19 infection, while a large effect for PM2.5 in the US is not found in the other three countries. The Population Attributable Fraction for COVID-19 incidence ranges from 3.4% in Canada to 45.9% in Italy, although with considerable uncertainty in these estimates.