Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Jun 11:10:20552076241261892.
doi: 10.1177/20552076241261892. eCollection 2024 Jan-Dec.

Change in disease burden associated with influenza and air pollutants during the COVID-19 pandemic in Hong Kong

Yanwen Liu  1 , Xie Jingyu  2 , Cai Cihan  1 , Hilda Tsang  3 , Shuya Lu  3 , Daihai He  1 , Lin Yang  3
Affiliations

Change in disease burden associated with influenza and air pollutants during the COVID-19 pandemic in Hong Kong

Yanwen Liu et al. Digit Health. .

Abstract

Objectives: This study aimed to estimate the variation in disease burden associated with air pollutants and other respiratory viruses during the COVID-19 pandemic.

Methods: We adopted a machine learning approach to calculate the excess mortality attributable to air pollutants and influenza, during the pre-pandemic and pandemic period.

Results: In the first 2 years of the COVID-19 pandemic, there were 8762 (95% confidence interval, 7503-9993), and 12,496 (11,718-13,332) excess all-cause deaths in Hong Kong. These figures correspond to 117.4 and 167.9 per 100,000 population, and 12.6% and 8.5% of total deaths in 2020 and 2021, respectively. Compared to the period before the pandemic, excess deaths from all-causes, cardiovascular and respiratory diseases, pneumonia and influenza attributable to influenza A and B significantly decreased in all age groups. However, excess deaths associated with ozone increased in all age-disease categories, while the relative change of nitrogen dioxide (NO2) and particular matters less than 10 µm (PM10) associated burden showed a varied pattern.

Conclusions: A notable shift in disease burden attributable to influenza and air pollutants was observed in the pandemic period, suggesting that both direct and indirect impacts shall be considered when assessing the global and regional burden of the COVID-19 pandemic.

Keywords: COVID-19; air pollution; influenza; machine learning; mortality.

PubMed Disclaimer

Conflict of interest statement

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Weekly all-cause and cause-specific mortality by age group, during the pre- and pandemic period. CRD, cardiovascular and respiratory diseases; P&I, pneumonia and influenza.
Figure 2.
Figure 2.
Observed and fitted weekly all-cause mortality data by age groups. The XGBoost (blue line) and GAM models (red line) were developed from the training data from 2014 to 2019 and used to predict the data in 2020 and 2021. XGBoost: eXtreme Gradient Boosting; GAM: general additive model.
Figure 3.
Figure 3.
Annual all-cause mortality associated with influenza A subtype H1N1 (red bar), H3N2 (orange bar), influenza B (pink bar), O3 (blue bar), NO2 (green bar), and PM10 (light green bar). The estimates were derived from the XGBoost model. XGBoost: eXtreme Gradient Boosting.
Figure 4.
Figure 4.
Comparison of annual all-cause excess mortality rate (per 100,000 population) associated with air pollutants, influenza A and B between the pre- and pandemic period, for different age groups, with 95% confidence interval (error bar) obtained from bootstrapping for 10,000 times.
See this image and copyright information in PMC

References

    1. WHO. Coronavirus disease (COVID-19) pandemic. 2020.
    1. Lai CK, Ng RW, Wong MC, et al. Epidemiological characteristics of the first 100 cases of coronavirus disease 2019 (COVID-19) in Hong Kong special administrative region, China, a city with a stringent containment policy. Int J Epidemiol 2020; 49: 1096–1105. - PMC - PubMed
    1. Wong MC, Ng RW, Chong KC, et al. Stringent containment measures without complete city lockdown to achieve low incidence and mortality across two waves of COVID-19 in Hong Kong. BMJ global Health 2020; 5: e003573. - PMC - PubMed
    1. Koh WC, Alikhan MF, Koh D, et al. Containing COVID-19: implementation of early and moderately stringent social distancing measures can prevent the need for large-scale lockdowns. Ann Glob Health 2020; 86: 88. - PMC - PubMed
    1. SAR HK. Government further tightens social distancing measures, 2020. https://www.info.gov.hk/gia/general/202007/27/P2020072700650.htm?fontSize=1 .

LinkOut - more resources