Environment/Climate Change
The Relationship between Long-Term Ambient Air Pollution Exposure, Neighborhood Environmental Vulnerability, and COVID-19 Pneumonia Morbidity in New York City Hospitalization Data Sneha Kannoth* Sneha Kannoth Cong Zhang Sandra S. Albrecht Alexander Azan Earle C. Chambers Min Qian Perry E. Sheffield Azure Thompson Jennifer A. Woo Baidal Stephanie Lovinsky-Desir Jeanette A. Stingone
Background
Research suggests geographic disparities in adverse COVID-19 outcomes are associated with air pollution. Social and structural factors at the neighborhood-level can lead to greater exposure to air pollution and increase vulnerability to the health effects of air pollution. We hypothesize that the link between air pollution and adverse COVID-19 is stronger in neighborhoods with social and structural factors that induce greater vulnerability to air pollution.
Methods
We used electronic health records from 5 New York City (NYC) health systems for COVID-19 hospitalizations (3/1-6/20/20), 11-year average air pollution ZIP Code estimates (particulate matter (PM2.5), nitrogen dioxide (NO2), black carbon (BC), ozone (O3)) from the NYC Community Air Survey (2009-2019), and a neighborhood environmental vulnerability index (NEVI) using US Census and CDC data. We constructed Poisson regression models with robust standard errors to estimate the risk ratios of COVID-19 pneumonia for each pollutant, adjusting for age, sex, body mass index, smoking, history of asthma, diabetes, hypertension, and effect modification by tertiles of NEVI.
Results
The sample included 7501 patients, of which 490 had COVID-19 pneumonia. Greater chronic exposure to air pollutants NO2 (RR:1.63; 95%CI:1.51,1.77), PM2.5 (RR:1.37; 95%CI:1.27,1.48), and BC (RR:1.44; 95%CI:1.31,1.59) was associated with greater risk of COVID-19 pneumonia. Inverse results were observed for O3 (RR:0.83; 95%CI:0.81,0.86). Relationships between chronic NO2, PM2.5, BC exposures and COVID-19 pneumonia were stronger among those living in areas of higher neighborhood-level vulnerability (p<0.05) (Fig1).
Conclusion
There is evidence to suggest that neighborhood-level vulnerability modifies the relationship between chronic air pollution exposure and COVID-19 pneumonia. Understanding the role that environmental exposures play in infectious disease severity requires understanding of community-level vulnerability to those exposures.
