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Race, Ethnicity, and Air pollution in COVID-19 Hospitalization OUTcomes (REACH OUT)

Principal Investigator: 

Columbia University

In this study the investigators will conduct a retrospective evaluation of the interactions between long-term exposure to air pollution and neighborhood vulnerability to adverse COVID-19 outcomes. They will investigate both single and multipollutant air pollution exposures in relation to COVID-19 hospitalization, inpatient length of stay, ICU admission, ventilator use, and death among a racially diverse population in New York City.

Funded under
In review

Poster abstract for HEI Annual Conference 2023

Traffic-related Air Pollution and Acute Respiratory Distress Syndrome among Hospitalized COVID-19 Patients in New York City

Jeanette A Stingone PhD, MPH1 Sneha Kannoth, MPH1, Cong Zhang, MS1, Sandra Albrecht, PhD, Alexander Azan MD2, MPH1, Earle C. Chambers, PhD, MPH3, Perry E. Sheffield, MD, MPH,4 Azure Thompson, DrPH, MPH5, Jennifer Woo Baidel, MD, MPH6, Stephanie Lovinsky-Desir, MD, MS6

1Columbia University, Mailman School of Public Health, New York, NY. USA

2 New York University, Langone Health New York, NY. USA

3Albert Einstein College of Medicine, Bronx, NY USA

4Icahn School of Medicine at Mount Sinai, New York, NY USA

5SUNY Downstate Health Sciences University, School of Public Health Brooklyn, NY USA

6Columbia University, Vagelos College of Physicians and Surgeons New York, NY USA

Background. New York City has experienced geographic disparities in COVID19-related morbidity and mortality, suggesting the importance of population-level exposures. The objective of this analysis was to estimate the association between historical exposure to nitrogen dioxide (NO2), a marker of traffic-related air pollution and development of acute respiratory distress syndrome (ARDS) while hospitalized for COVID-19.

Methods. This analysis is nested within the Race Ethnicity and COVID-19 Hospitalization Outcomes (REACH-OUT) study. The goals of REACH-OUT are to determine if air pollution exposure interacts with socioeconomic vulnerabilities at the neighborhood level to contribute to observed disparities in COVID-19 outcomes. Our study population was drawn from a repository of electronic health record data from 5 large health systems in New York City and included individuals hospitalized with a diagnosis of COVID-19 during the first phase of the pandemic (March 1-June 30, 2020). To reduce potential for selection bias, we restricted our population to ZIP Codes where the EHR repository captured at least 40% of total COVID hospitalizations, based on New York City public health data. The primary outcome was an ICD-10 code for ARDS. We assigned historical NO2 exposure using 11-year averages derived from ZIP Code area estimates from the 2009-2019 New York City Community Air Survey. We constructed Poisson regression models with robust standard errors to estimate the relative risk of ARDS associated with NO2, adjusting for age, sex, BMI category, smoking and a neighborhood-level measure of sociodemographic vulnerability (NEVI). We also assessed interaction between NO2 and the NEVI metric through inclusion of interaction terms.

Results. Our study population consisted of 7,970 patients, of whom 1296 had a diagnosis of ARDS during their hospitalization. In adjusted models, a 5-unit increase in NO2 was associated with a risk ratio of 1.31 (95%CI 1.18, 1.45) when NEVI was fixed at the NYC average. We observed evidence of synergistic interaction between NO2 and the NEVI metric (β=0.05, p=0.002). Similar patterns were seen in the full study population.

Conclusions. This preliminary analysis suggests greater COVID-19 morbidity among individuals living in neighborhoods with higher historic levels of traffic-related air pollution and socioeconomic vulnerability. Future work will determine if these patterns persisted during subsequent phases of the pandemic.