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

在拉丁美洲，约有1.72亿人或58%的人口生活在366个城市，这些城市的居民超过100,000人，所有这些城市的环境空气污染水平都超过了世卫组织建议的PM2.5年平均水平10μ克/立方米。无论是短期还是长期暴露于AAP，都与心血管和呼吸系统疾病的较高发病率和死亡率有关，而且阿尔茨海默病和痴呆症的证据也越来越多。2010年至2016年，秘鲁最大城市利马的AAP平均为25μg/m~3。2018年，第二大城市阿雷基帕在市中心的监测仪上平均为72μg/m3。这两个城市都远远高于世卫组织10μ克/立方米的指导方针。与许多其他LMIC一样，秘鲁的AAP监测是有限的；政府采取的大多数观测仅限于利马和少数地面监测员。我们建议将之前的(2010-2016)1 k2分辨率的利马PM2，5模型延长到2025年，并开发一个新的NO2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策略。我们还将研究急性肺炎和新冠肺炎(以及所有肺炎)在引入疫苗前一年利马的发病率、死亡率和病死率之间的关系；秘鲁受到新冠肺炎的重创，是世界上新冠肺炎死亡率最高的国家。我们还将评估严重的新冠肺炎是否与2-4年后的认知障碍有关，将100例患者与100名对照组进行比较。此外，我们将在利马进行第一项关于阿尔茨海默病(AD)、额颞叶痴呆(FTD)和空气污染的研究，利用一家领先的阿尔茨海默病中心正在进行的一项包括500多名患者和500名对照的队列研究；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冠状病毒病。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建立相应的医院数据和急诊室就诊数据库。根据这些数据，我们将估计秘鲁PM2.5引起的心血管和呼吸系统疾病的过早死亡率。我们还可能将我们对阿尔茨海默氏症的研究扩展到利马以外的其他城市中心。我们还将在全国范围内研究可能的PM2.5减排战略，这将减少PM2.5和温室气体(来自许多相同来源)，并研究它们对秘鲁在巴黎协议下减少温室气体义务的影响。

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.