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.

Project Narrative The proposed research builds on our previous work in the region and is designed to enhance capacity to carry out research and provide data useful to policy makers in our focus area of building capacity in Ambient Air Pollution (AAP) research in Peru and study the association between AAP and cardiovascular, respiratory, and neurodegenerative health outcomes, including COVID-19 and Alzheimer’s where the association with AAP is not well established. Emory University will submit the linked research training grant application, which is titled “2/2 – Regional Geohealth Hub centered in Peru –US.”