COVID-19 mortality in Istanbul in association with air pollution and socioeconomic status: an ecological study

This study aims to reveal the relationship between the COVID-19 mortality indicators and socioeconomic status (SES) and air pollution. In this ecological study, the focus was put on the relationship between COVID-19 mortality and both air quality and socioeconomic status at the district level in Istanbul. The mortality variables of the study are the excess deaths due to the pandemic, the proportion of deaths due to the pandemic among all deaths, COVID-19 mortality rate (per 100,000), and the proportion of COVID-19 deaths among older people (above the age of 65). The daily air quality measurements of PM(10), SO(2), NO(2), and NO(x) of the pre-pandemic term were included in the research to avoid bias due to decreasing traffic burden during the pandemic. Partial correlation was applied to analyze the relationship between air quality and mortality measures by controlling socioeconomic status, the percentage of the older population, and household size. Every 20% deterioration in the SES stratum has contributed to a 4% increase in excess mortality at the district level. The elderly population ratio of over 10% in the districts was found to increase the COVID-19 deaths in the total population by 35% and the deaths in the population over 65 years old by 3%. Average household size was correlated with COVID-19 deaths in the population over 65. A moderate correlation was found between the COVID-19 mortality rate per 100,000 population and PM(10), SO(2), and NO(2) (r = 0.413, 0.421, and 0.431, respectively). Mortality during the COVID-19 pandemic in Istanbul is related to an interaction of socioeconomic characteristics and air pollution as an environmental issue.