The Rises of Coronavirus Disease (COVID-19) death rate in Japan with high PM2.5

doi:10.21203/rs.3.rs-27475/v1

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The Rises of Coronavirus Disease (COVID-19) death rate in Japan with high PM_2.5

https://doi.org/10.21203/rs.3.rs-27475/v1

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Currently vulnerable age groups in most countries are affected by the respiratory -coronavirus disease 2019 (COVID-19). Long-term-exposure to high levels of PM_2.5 (particulate matter with aerodynamic diameter ≤ 2.5μm) is also associated positively with repository deaths. The aim of this study is to find if high PM_2.5 levels affect COVID-19 caused deaths in Japan. COVID-19 caused death and tested positive cases in all prefectures during the study period from Feb. 18 up to Apr. 16, 2020 are analyzed. PM_2.5 caused deaths from 2010 to 2017 are calculated based on PM_2.5-relative risk (RR) of 1.04 (95% CI: 1.01 – 1.08) from the World Health Organization-Air Quality Guidelines (WHO–AQG). The findings of this study show that old people who are living in prefectures with high levels of PM_2.5 are the most vulnerable to COVID-19. The estimated death cases from 2010 to 2017 are about 115,532 (95% CI: 28,883 - 231,064) cases. Thus; policy decision makers could consider PM_2.5 data to support their efforts not only to minimize the spread of COVID-19, but also to improve air quality.

Environmental Engineering

Environmental Chemistry

PM2.5

COVID-19

respiratory-death

Japan

long-term exposure

vulnerable groups

A recent study from Wuhan, China, by Zhou F., et al., (2020) has shown an association between adverse health effects among elders and COVID-19. Another recent study from United State by Wu X., and Nethery R., (2020) has examined the association between long-term exposure to air pollution and COVID-19 deaths, they found a strong association between elevated PM_2.5 and increased COVID-19 death rates. In Japan, the information issued by the Ministry of Health, Labor and Welfare (MoHLW) show that, up to April 16, 2020, there are 4,168 tested positive and 81 death cases caused by COVID-19 (Ogiwara K, 2020). Long-term-exposure to high levels of PM_2.5(particulate matter with aerodynamic diameter ≤ 2.5μm) is also associated positively with repository deaths (Pope III et al., 2002; Pope III and Dockery, 2006; Lippmann, 2009; Jerrett et al., 2009). Additionally, in Japan there are many published studies listed in Nawahda (2012 and 2014) about the effects of PM_2.5 on human health. Thus; the information about the distribution of PM_2.5 levels and COVID-19 deaths and tested positive cases, from Feb. 18 up to Apr. 16^th, 2020, in all prefectures in Japan are analyzed. The deaths due to long-term exposure to PM_2.5 are calculated from 2010 to 2017 based on the relative risk (RR) of 1.04 (95% CI: 1.01 – 1.08). This RR value is associated with 10 μgm⁻³ change in PM_2.5 mean annual concentration (Pope III et al., 2002). The findings of this study show that old people who are living in prefectures with high levels of PM_2.5 are the most vulnerable to COVID-19. Thus; this study provides a better understand of possible association between air quality management and COVID-19 and the corresponding policies to minimizing the adverse effects on human health.

PM_2.5 monitoring data

Daily PM_2.5 data for an 8-year period (2010 – 2017) from 1,064 Air Quality monitoring Systems (AQMSs) in Japan are made available by the National Institute of Environmental Studies (NIES). These AQMSs (Fig. 1.) are deployed by the Ministry of Environment (MoE) and local governments. The mean annual concentrations of PM_2.5 from 2011 to 2017 are shown in Fig.2.

Coronavirus COVID-19 Japan Cases

MoLHW provides the following information related to COVID-19 cases in Japan; tested positive, with symptoms, discharged, PCR tested, serious, deaths, and by ages for all prefectures in Japan. Fig. 3., shows the number of reported death cases up to April 16^th , 2020, most of the cases belong to +60-year age group.

Effect of long-term eexposure to PM_2.5

The annual deaths caused by long-term exposure to high levels of PM_2.5 are calculated as follows,

death(x,t) = pop(x,i) M_b β_PM2.5△PM_2.5(x,t) (1)

where x is the prefecture index, t is the year of simulation, pop is the exposed population, i is the index of age group, △PM_2.5 is the change in the annual mean levels, M_b is the annual mean baseline death rate, and β_PM2.5 equals 0.004 (Nawahda, 2014). An increase of 10 μgm^-3 annual mean of PM_2.5 caused a 4% (95% CI: 1.01–1.08) increase in death rate for the age group of +30-year (Pope III et al., 2002).

The Population of all 47 prefectures in Japan in 2015 is collected from the database of the Official Statistics of Japan (e-stat, 2015). The population is divided into four age groups, 0-14; 15-64; 65-74; and +75. The corresponding percentage of each age group is as follows, 13.76%; 66.08%; 11.05%; and 9.11%, respectively. The corresponding baseline mortality (per one thousand) of each group is as follows, 0.3; 2.25; 14.28; and 59.01, respectively (Nawahda, 2014). The first two age groups are ignored due to the limitation of Eq. (1) that is valid for +30-year age groups.

The calculated annual deaths in all prefectures in Japan from 2010 to 2017 caused by exposure to PM_2.5 > 10 μgm^-3 for the +65-year age groups are listed in Table 1.

Table 1. Total death cases caused by exposure to PM_2.5 in Japan from 2010 to 2017.

Year	Death cases	95% CI
2010	20,469	5,117	40,938
2011	18,826	4,707	37,652
2012	18,044	4,511	36,087
2013	17,776	4,444	35,552
2014	15,728	3,932	31,455
2015	10,957	2,739	21,914
2016	7,063	1,766	14,126
2017	6,669	1,667	13,339

The calculated death cases due to exposure to PM_2.5>10 μgm^-3 during the study period from 2010 to 2017 are shown in Fig. 4. The death cases among the +75-year age group are around 3.4 times as much as the third age group. Better air quality of the year 2017 compared to 2010 could save the lives of around 13,600 inhabitants. Figure 5, shows that that old people who are living in prefectures with high PM_2.5 levels are the most vulnerable to COVID-19.

The calculated death cases due to exposure to PM_2.5 in all prefectures in Japan are estimations based on RR value of 1.04. These estimations are conservative; if a higher value of RR is considered, e.g. 1.08 (Jerrett et al., 2009) for PM_2.5 levels > 10 ugm-3, the estimated deaths will increase accordingly. In 2009 Japan Ministry of Environment (MoE) adopted the following air quality standards of PM_2.5; 15 μgm^-3/35μgm^-3(mean annual standard / 24 hours standard). These standards are similar to the U.S.EPA PM_2.5-guidelines (USEPA, 2010) but different from the World Health Organization-Air quality Guidelines (WHO-AQG), which are; 10 μgm^-3/20 μgm^-3(WHO, 2005). According to Figures 2 and 6 the mean annual standard is met almost in all prefectures in Japan. This indicates a yearly improving air quality. However; during the study period the 24 hours standard is exceeded mainly in the southern prefectures in Japan. This could be due to the yellow dust storms.

There is uncertainty in the method of estimating the effects of long-term exposure to high levels of PM_2.5 as discussed in (Nawahda, 2014). This uncertainty is mainly caused by using a non-Asian CR function and population data (e.g. counts, percentage of each age group, and the corresponding baseline mortality) of the 8-year study period.

The aim of this study is to find if PM_2.5affects COVID-19 caused deaths in Japan. COVID-19 caused death and tested positive cases in all prefectures during the study period from Feb. 18 up to Apr. 16, 2020 are analyzed. The prefectures with high levels of PM_2.5 have the highest COVI-19 death and tested positive cases. Accordingly; old people living in places with high concentration of PM_2.5 are the most vulnerable to COVID-19. The findings of this study are a step towards a better understanding of the association between PM_2.5 and COVID-19. PM_2.5 caused deaths from 2010 to 2017 are calculated based on PM_2.5-relative risk (RR) of 1.04 (95% CI: 1.01 – 1.08) from the World Health Organization-Air Quality Guidelines (WHO–AQG)_. The estimated death cases from 2010 to 2017 are about 115,532 (95% CI: 28,883 - 231,064) cases. Thus; policy decision makers could consider PM_2.5 data to support their efforts in minimizing the spread of COVID-19.

The author of "The Rises of Coronavirus Disease (COVID-19) death rate in Japan with high PM2.5" declares no competing interests.

Acknowledgement

Thanks for my parents and my wife, and thanks for Palestine Technical University-Kadoorie (PTUK) for their support. Also, thanks for Japan Ministry of Environment for providing PM_2.5 data.

e-stat: Official statistics of Japan (in Japanese/English), accessed in April, 8, 2020; http://www.e-stat.go.jp/SG1/estat/eStatTopPortalE.do.

Jerrett M., Burnett R., Pope III A., et al. 2009. Long-term ozone exposure and mortality. The New England Journal of Medicine, 360, 11: 1085-1095.

Lippmann M, 2009. Environmental toxicants / human exposures and their effects, John Wiley & Sons Inc., New Jersey, pp. 317–359.

MOE, 2020. Air quality monitoring data. Accessed in April 8, 2020. http://www.env.go.jp/en/

Nawahda A. (2014). Reductions of PM2.5 Air Concentrations and Possible Effects on Premature Mortality in Japan. Water, Air, and Soil Pollution,224 (4): 1508. DOI 10.1007/s11270-013-1508-2

Nawahda, A., Yamashita, K., Ohara, T., Kurokawa, J., Yamaji, K. (2012) Evaluation of premature mortality caused by exposure to PM2.5 and ozone in East Asia: 2000, 2005, 2020, Water, Air, & Soil Pollution.223 (6), 3445-3459, 2012. DOI 10.1007/s11270-012-1123-7.

Ogiwara K., Coronavirus Disease (COVID-19) situation report in Japan. Toyo Keizai Online. 2020. Accessed Apr. 17, 2020 (https://toyokeizai.net/sp/visual/tko/covid19/en.html#index-each-prefecture)

Pope III, C A, Burnett R T, Thun, M J, et al., 2002. Lung cancer, cardiopulmonary mortality, and long-term exposure to fine particulate air pollution. Journal of American Medical Association, 287 (9): 1132-1141

Pope III C A, Dockery W D. 2006, Health effects of fine particulate air pollution: Lines that connect. Journal of Air & Waste Management Association, 56:709-742.

US-EPA. Quantitative Health Risk Assessment for PM, 2010,http://www.epa.gov/ttn/naaqs/standards/pm/data/PM_RA_FINAL_June_2010.pdf

WHO, World Health Organization, 2005. Air Quality Guidelines for Particulate

Matters, Ozone, Nitrogen Dioxide/Global Update/Summary of Risk Assessment.http://whqlibdoc.who.int/hq/2006/WHO_SDE_PHE_OEH_06.02_eng.pdf.

Wu, X., Nethery, C., Sabath, B., Braun, D., Dominici, F., Exposure to air pollution and COVID-19 mortality in the United States., medRxiv 2020.04.05.20054502; doi: https://doi.org/10.1101/2020.04.05.20054502

Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study [published correction appears in Lancet. 2020 Mar 28;395(10229):1038] [published correction appears in Lancet. 2020 Mar 28;395(10229):1038]. Lancet. 2020;395(10229):1054–1062. doi:10.1016/S0140-6736(20)30566-3

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The Rises of Coronavirus Disease (COVID-19) death rate in Japan with high PM_2.5

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