Air Pollution, COVID-19-related Air-quality Changes, and Premature Mortality in Türkiye (2019-2023)

Long-term exposure to fine particulate matter (PM_2.5) contributes to about 8 million premature deaths worldwide annually. In Türkiye, few studies have examined long-term health impacts, particularly during and after the coronavirus disease-2019 (COVID-19) pandemic. This study aimed to estimate premature mortality and the respiratory disease burden attributable to PM_2.5 from 1 January 2019 to 31 December 2023.

Premature deaths attributable to PM_2.5 were estimated using the World Health Organization's (WHO) AirQ+ software. Inputs included annual provincial PM_2.5 concentrations (measured directly or at stations without PM_2.5 measurements, converted from PM₁₀ using the WHO-recommended factor of 0.67 for Türkiye), mortality data for individuals aged ≥25 years, and demographic data from Turkish Statistical Institute. The Estimates focused on chronic obstructive pulmonary disease (COPD) and lung cancer. Population attributable fractions were calculated. Temporal comparisons were made across pre-pandemic (2019), pandemic (2020-2021), and post-pandemic (2022-2023) periods to capture potential effects of COVID-19-related reductions in industrial production and traffic. Differences were assessed using one-way ANOVA.

An annual average of 85,344 premature deaths (95% confidence interval: 79,129-91,559) was attributable to PM_2.5. COPD and lung cancer accounted for a significant share of PM_2.5-related deaths, with about one in seven linked to COPD. Although temporary improvements in air quality occurred during the COVID-19 pandemic, no statistically significant difference was observed in COPD-attributable mortality across the three study periods (P = 0.687).

Air pollution remains a major public health challenge in Türkiye. Sustained, region-specific strategies are needed to reduce the burden of PM_2.5-related mortality. Inadequate monitoring coverage continues to limit precision in exposure and risk assessment.