In 2019, 476,000 infants worldwide died in their first month of life from health effects associated with air pollution exposure, a team of international researchers estimate in the State of Global Air 2020 report.

“The number is just staggering,” epidemiologist Rakesh Ghosh at the University of California, San Francisco, who led the study, told NPR.

Although most of these deaths were in low-income countries where families must use coal or wood for heating and cooking, air pollution was a factor in 521 deaths of newborns in the United States.

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“While the biological reasons for the linkage between air pollution and adverse birth outcomes are not fully known, it is thought that air pollution may affect a pregnant woman, her developing fetus, or both in ways analogous to tobacco smoking, which is a well-known risk factor for low birth weight and preterm birth,” the researchers wrote.

Newborns aren’t the only demographic affected by air pollution, however.

Long-term exposure to ground-level ozone (smog) is associated with the development of chronic obstructive pulmonary disease — COPD — which is a progressive and debilitating disease that makes it harder to breathe.

Fifteen of the 20 most populous countries experienced increases in ozone-attributable deaths over the past decade. The largest proportional increases were seen in Brazil (which saw a 191% increase in ozone-attributable deaths), Ethiopia (171%), the Democratic Republic of the Congo (97%), and Indonesia (89%).

Five metro area counties received a failing grade for ozone pollution in the American Lung Association’s 2019 State of the Air report.

DeKalb, Fulton, Gwinnett, Henry and Rockdale counties all received an “F” for ozone pollution levels tracked from 2015 to 2017, the three year period measured in the report, the AJC’s Nedra Rhone reported.

Although lockdowns intended to stop the spread of the coronavirus have lowered pollution levels worldwide, that benefit is likely temporary as more cities relax restrictions in an effort to restart their economies.

Understanding air pollution’s health consequences is key to informing air quality interventions and saving lives, according to the Institute for Health Metrics and Evaluation, one of the report’s partners. Air pollution contributed to 6.7 million deaths in 2019, researchers found. It’s impact was exceeded by only high blood pressure, dietary risks and tobacco use.