{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T18:20:15Z","timestamp":1791570015232,"version":"4.3.4"},"reference-count":13,"publisher":"Pan American Health Organization","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,11,20]]},"abstract":"<p><bold>Objective.<\/bold> To examine the impact of four ambient air pollutants on the COVID-19 mortality rate in the United States of America.<\/p>\n<p><bold>Methods.<\/bold> Using publicly accessible data collected by the United States Census Bureau, Environmental Protection Agency, and other agencies, county-level mortality rates were regressed on concentration values of ground-level ozone, nitrogen dioxide, carbon monoxide, and sulfur dioxide. Four confounder variables were included in the regression analysis: median household income, rate of hospital beds, population density, and days since first confirmed case.<\/p>\n<p><bold>Results.<\/bold> Regression analysis showed that ground-level ozone is positively correlated with county-level mortality rates regardless of whether confounders are controlled for. Nitrogen dioxide is also shown to have a direct relationship with county-level mortality rates, except when all confounders are included in the analysis.<\/p>\n<p><bold>Conclusions.<\/bold> High ground-level ozone and nitrogen dioxide concentrations contribute to a greater COVID-19 mortality rate. To limit further losses, it is important to reflect research findings in public policies. In the case of air pollution, environmental restrictions should be reinforced, and extra precautions should be taken as facilities start reopening.<\/p>","DOI":"10.26633\/rpsp.2020.159","type":"journal-article","created":{"date-parts":[[2020,11,20]],"date-time":"2020-11-20T18:52:35Z","timestamp":1605898355000},"page":"1","source":"Crossref","is-referenced-by-count":19,"title":["Ambient air pollutants and their effect on COVID-19 mortality in the United States of America"],"prefix":"10.26633","volume":"44","author":[{"given":"Samuel","family":"Liu","sequence":"first","affiliation":[{"name":"Vanderbilt University, Nashville, United States of America"},{"name":"samuel.l.liu@vanderbilt.edu"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meng","family":"Li","sequence":"additional","affiliation":[{"name":"Roosevelt University, Chicago, United States of America"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"11167","reference":[{"key":"ref1","unstructured":"Welna D. \u2018We All Feel At Risk\u2019: 100,000 People Dead From COVID-19 In The U.S. [Internet]. NPR. 2020 May 27 [cited 2020 Sep 7]. Available from: https:\/\/www.npr.org\/2020\/05\/27\/860508864\/we-all-feel-at-risk-100-000-people-dead-from-covid-19-in-the-u-s"},{"key":"ref2","doi-asserted-by":"crossref","unstructured":"Wang L, He W, Yu X, Hu D, Bao M, Liu H, et al. Coronavirus disease 2019 in elderly patients: characteristics and prognostic factors based on 4-week follow-up. J Infect. 2020;80(6):639\u201345. https:\/\/doi.org\/10.1016\/j.jinf.2020.03.019","DOI":"10.1016\/j.jinf.2020.03.019"},{"key":"ref3","doi-asserted-by":"crossref","unstructured":"Rich DQ. Accountability studies of air pollution and health effects: lessons learned and recommendations for future natural experiment opportunities. Environ Int. 2017;100:62\u201378. https:\/\/doi.org\/10.1016\/j.envint.2016.12.019","DOI":"10.1016\/j.envint.2016.12.019"},{"key":"ref4","doi-asserted-by":"crossref","unstructured":"Atkinson RW, Butland BK, Anderson HR, Maynard RL. 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