1/2 - Regional GEOhealth Hub Centered In Peru-Peru

在拉丁美洲，约有1.72亿或58%的人口居住在366个城市，人口超过10万，所有这些城市的环境空气污染水平（AAP）均高于世卫组织建议的PM2.5年均值10微克/立方米的水平。短期和长期暴露于AAP与心血管和呼吸系统疾病的发病率和死亡率较高相关，并且阿尔茨海默病和痴呆症的证据也越来越多。2010-2016年，秘鲁最大城市利马的AAP平均值为25微克/立方米。第二大城市阿雷基帕在2018年的市中心监测中平均为72微克/立方米。这两个城市都远高于世卫组织10微克/立方米的指导标准。与许多其他低收入国家一样，秘鲁的AAP监测有限;政府的大多数观察仅限于利马和少数地面监测员。我们建议将我们之前（2010-2016）的1 k2分辨率PM2，5模型扩展到2025年，并为NO2开发一个新的利马模型。利用这些数据，我们将研究利马交通和空气污染的关系，并评估在减少空气污染和相关呼吸道疾病方面可能采取的不同缓解战略。我们还将研究在引入疫苗接种前一年，利马的AAP和COVID-19（以及所有肺炎）发病率、死亡率和病死率之间的关系;秘鲁受到COVID-19的严重打击，并拥有世界上最高的COVID-19死亡率。我们还将评估严重的COVID-19是否与2-4年后的认知缺陷相关，比较100例病例和100例对照。此外，我们将利用一家领先的阿尔茨海默病中心正在进行的队列研究，对利马的阿尔茨海默病（AD）和额颞叶痴呆症（FTD）以及空气污染进行首次研究，该研究有500多例病例和500例对照;在这项研究中，我们还将评估阿尔茨海默病病例或额颞叶痴呆病例是否比对照组更有可能患有COVID。我们还计划为整个秘鲁开发一个5 k2分辨率的PM2.5国家模型，并为该国所有主要城市开发一个相应的医院数据和急诊室访问数据库。通过这些数据，我们将估计秘鲁因PM2.5引起的心血管和呼吸系统疾病的过早死亡率。我们还可以将我们对阿尔茨海默病的研究扩展到利马以外的其他城市中心。我们将进一步研究全国范围内可能的PM2.5缓解战略，这将减少PM2.5和温室气体（由许多相同的来源产生），并研究其对秘鲁根据巴黎雅阁减少温室气体的义务的影响。

In Latin America, about 172 million or 58% of the population, live in 366 cities comprising over 100,000 residents, all of which have ambient air pollution (AAP) levels above WHO recommended level of 10 μg/m3 annual average for PM2.5. Exposure to AAP, both short and long-term, is associated with higher morbidity and mortality from cardiovascular and respiratory diseases, and there is increasing evidence for Alzheimer’s disease and dementia as well. AAP in Lima, Peru’s largest city, averaged 25 μg/m3 in 2010-2016. The 2nd largest city, Arequipa, averaged 72 μg/m3 at a downtown monitor in 2018. Both cities are far above WHO guidelines of 10 μg/m3. As in many other LMICs, AAP monitoring in Peru is limited; most observations taken by the government are limited to Lima and to a few ground monitors. We propose to extend our prior (2010-2016) 1 k2 -resolution PM2,5 model for Lima through 2025, and also develop a new Lima model for NO2. With these data we will study the association of traffic and air pollution in Lima and evaluate possible different mitigation strategies in terms of reducing air pollution and related respiratory diseases. We will also study the association of AAP and COVID-19 (and all pneumonia) incidence, mortality, and case-fatality in Lima in the year before vaccination was introduced; Peru was hit hard by COVID-19, and has the highest COVID-19 mortality rate in the world. We will also assess whether severe COVID-19 is associated with cognitive deficits 2-4 years afterwards, comparing 100 cases with 100 controls. In addition, we will conduct the first study of Alzheimer disease (AD) and fronto-temporal dementia (FTD) and air pollution in Lima, taking an advantage of an ongoing cohort study with over 500 cases and 500 controls, conducted by a leading Alzheimer’s disease center; in this study we will also assess whether Alzheimer’s disease cases, or fronto-temporal dementia cases were more likely to have had COVID than controls. We also plan to develop a national model for PM2.5 for Peru as a whole, with 5 k2 resolution, and a corresponding data base of hospital data and emergency room visits for all the major cities of the country. With these data we will estimate premature mortality from cardiovascular and respiratory disease due to PM2.5 in Peru. We may also be able to extend our study of Alzheimer’s disease to other urban centers outside of Lima. We will furthermore study possible mitigation strategies for PM2.5 nationwide, which will reduce both PM2.5 and greenhouse gases (produced from many of the same sources), and study their impact on Peru’s obligations to reduce greenhouse gases under the Paris accord.