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Casey JA, Daouda M, Babadi RS, Do V, Flores NM, Berzansky I, González DJ, Van Horne YO, James-Todd T. Methods in Public Health Environmental Justice Research: a Scoping Review from 2018 to 2021. Curr Environ Health Rep 2023; 10:312-336. [PMID: 37581863 PMCID: PMC10504232 DOI: 10.1007/s40572-023-00406-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2023] [Indexed: 08/16/2023]
Abstract
PURPOSE OF REVIEW The volume of public health environmental justice (EJ) research produced by academic institutions increased through 2022. However, the methods used for evaluating EJ in exposure science and epidemiologic studies have not been catalogued. Here, we completed a scoping review of EJ studies published in 19 environmental science and epidemiologic journals from 2018 to 2021 to summarize research types, frameworks, and methods. RECENT FINDINGS We identified 402 articles that included populations with health disparities as a part of EJ research question and met other inclusion criteria. Most studies (60%) evaluated EJ questions related to socioeconomic status (SES) or race/ethnicity. EJ studies took place in 69 countries, led by the US (n = 246 [61%]). Only 50% of studies explicitly described a theoretical EJ framework in the background, methods, or discussion and just 10% explicitly stated a framework in all three sections. Among exposure studies, the most common area-level exposure was air pollution (40%), whereas chemicals predominated personal exposure studies (35%). Overall, the most common method used for exposure-only EJ analyses was main effect regression modeling (50%); for epidemiologic studies the most common method was effect modification (58%), where an analysis evaluated a health disparity variable as an effect modifier. Based on the results of this scoping review, current methods in public health EJ studies could be bolstered by integrating expertise from other fields (e.g., sociology), conducting community-based participatory research and intervention studies, and using more rigorous, theory-based, and solution-oriented statistical research methods.
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Affiliation(s)
- Joan A. Casey
- University of Washington School of Public Health, Seattle, WA USA
- Columbia University Mailman School of Public Health, New York, NY USA
| | - Misbath Daouda
- Columbia University Mailman School of Public Health, New York, NY USA
| | - Ryan S. Babadi
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Vivian Do
- Columbia University Mailman School of Public Health, New York, NY USA
| | - Nina M. Flores
- Columbia University Mailman School of Public Health, New York, NY USA
| | - Isa Berzansky
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, USA
| | - David J.X. González
- Department of Environmental Science, Policy & Management and School of Public Health, University of California, Berkeley, Berkeley, CA 94720 USA
| | | | - Tamarra James-Todd
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, USA
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Ali SMA, Sherman-Morris K, Meng Q, Ambinakudige S. Longitudinal disparities in social determinants of health and COVID-19 incidence and mortality in the United States from the three largest waves of the pandemic. Spat Spatiotemporal Epidemiol 2023; 46:100604. [PMID: 37500229 DOI: 10.1016/j.sste.2023.100604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 06/01/2023] [Accepted: 07/14/2023] [Indexed: 07/29/2023]
Abstract
The United States experienced at least five COVID-19 waves linked with different mutated SARS-CoV-2 variants including Alpha, Delta and Omicron. In addition to the variants, the intensity, geographical distribution, and risk factors related to those waves also vary within socio-demographic characteristics and timeframes. In this project, we have examined the spatial and temporal pattern of COVID-19 in the USA and its associations with Social Determinants of Health (SDoH) by utilizing the County Health Rankings & Roadmaps (CHRR) dataset. Our epidemiologic investigation at the county level showed that the burden of COVID-19 cases and deaths is higher in counties with high percentages of smoking, number of preventable hospital stays, primary care physician rate, the average daily density of PM2.5 and percentages of high proportions of Hispanic residents. In addition, the analysis also demonstrated that COVID-19 incidence and mortality had distinct characteristics in their association with SDoH variables. For example, the percentages of the population 65 and older had negative associations with incidence while a significant positive association with mortality. In addition to the elderly population, median household income, unemployment, and number of drug overdose deaths showed a mixed association with COVID-19 incidence and mortality. Our findings validate several influential factors found in the existing social epidemiology literature and highlight temporal associations between SDoH variables and COVID-19 incidence and mortality not yet frequently studied.
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Affiliation(s)
- S M Asger Ali
- Polis Center, Indiana University Purdue University Indianapolis (IUPUI), Indianapolis, USA.
| | | | - Qingmin Meng
- Department of Geosciences, Mississippi State University, Starkville, USA.
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Anneser E, Stopka TJ, Naumova EN, Spangler KR, Lane KJ, Acevedo A, Griffiths JK, Lin Y, Levine P, Corlin L. Environmental equity and COVID-19 experiences in the United States: Results from three survey waves of a nationally representative study conducted between 2020-2022. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.05.16.23290050. [PMID: 37293071 PMCID: PMC10246057 DOI: 10.1101/2023.05.16.23290050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Certain environmental exposures, such as air pollution, are associated with COVID-19 incidence and mortality. To determine whether environmental context is associated with other COVID-19 experiences, we used data from the nationally representative Tufts Equity in Health, Wealth, and Civic Engagement Study data (n=1785; three survey waves 2020-2022). Environmental context was assessed using self-reported climate stress and county-level air pollution, greenness, toxic release inventory site, and heatwave data. Self-reported COVID-19 experiences included willingness to vaccinate against COVID-19, health impacts from COVID-19, receiving assistance for COVID-19, and provisioning assistance for COVID-19. Self-reported climate stress in 2020 or 2021 was associated with increased COVID-19 vaccination willingness by 2022 (odds ratio [OR] = 2.35; 95% confidence interval [CI] = 1.47, 3.76), even after adjusting for political affiliation (OR = 1.79; 95% CI = 1.09, 2.93). Self-reported climate stress in 2020 was also associated with increased likelihood of receiving COVID-19 assistance by 2021 (OR = 1.89; 95% CI = 1.29, 2.78). County-level exposures (i.e., less greenness, more toxic release inventory sites, more heatwaves) were associated with increased vaccination willingness. Air pollution exposure in 2020 was positively associated with likelihood of provisioning COVID-19 assistance in 2020 (OR = 1.16 per μg/m3; 95% CI = 1.02, 1.32). Associations between certain environmental exposures and certain COVID-19 outcomes were stronger among those who identify as a race/ethnicity other than non-Hispanic White and among those who reported experiencing discrimination; however, these trends were not consistent. A latent variable representing a summary construct for environmental context was associated with COVID-19 vaccination willingness. Our results add to the growing body of literature suggesting that intersectional equity issues affecting likelihood of exposure to adverse environmental conditions are also associated with health-related outcomes.
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Affiliation(s)
- Elyssa Anneser
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Thomas J. Stopka
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
- Tufts Clinical and Translational Sciences Institute, Boston, MA, USA
| | - Elena N. Naumova
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
- Department of Civil and Environmental Engineering, Tufts University School of Engineering, Medford, MA, USA
- Division of Nutrition Epidemiology and Data Science, Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Keith R. Spangler
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Kevin J. Lane
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Andrea Acevedo
- Department of Community Health, Tufts University School of Arts and Sciences, Medford, MA, USA
| | - Jeffrey K. Griffiths
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
- Department of Civil and Environmental Engineering, Tufts University School of Engineering, Medford, MA, USA
- Department of Infectious Disease and Global Health, Tufts University Cummings School of Veterinary Medicine, Grafton, MA, USA
- Division of Geographic Medicine and Infectious Diseases, Department of Medicine, Tufts Medical Center, Boston, MA
| | - Yan Lin
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Peter Levine
- Jonathan Tisch College of Civic Life, Tufts University, Medford, MA, USA
| | - Laura Corlin
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
- Department of Civil and Environmental Engineering, Tufts University School of Engineering, Medford, MA, USA
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Querdibitty CD, Campbell J, Wetherill MS, Salvatore AL. Geographic and social economic disparities in the risk of exposure to ambient air respiratory toxicants at Oklahoma licensed early care and education facilities. ENVIRONMENTAL RESEARCH 2023; 218:114975. [PMID: 36462693 DOI: 10.1016/j.envres.2022.114975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 11/24/2022] [Accepted: 11/28/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Early life exposures to hazardous air pollutants has been associated with adverse asthma-related outcomes. Neighborhood-level social and economic factors play an essential role in the distribution of hazardous air pollutants and children spend a substantial amount of time at early care and education (ECE) facilities. While the indoor air quality of these facilities has been described, particularly for criteria air pollutants such as volatile organic compounds and particulate matter, little is known about the ambient air quality of ECE facilities. OBJECTIVES We conducted a cross-sectional study to estimate the ambient air quality of Oklahoma licensed ECE facilities and to explore associations between ambient air quality and select geographic predictors. METHODS We estimated ambient air quality using the total respiratory hazard quotient from the National Air Toxics Assessment according to the geographical location of licensed Oklahoma ECE facilities (N = 3184). We then determined whether urban and rural ECE facilities' air respiratory toxicant exposure risk differed by ECE facilities' neighborhood-level social and economic inequities including: 1) racial-ethnic minority community, 2) neighborhood socioeconomic status, and 3) residential segregation. RESULTS Urban ECE facilities in Hispanic segregated counties were five times more likely to be at risk of high air respiratory exposure, adjusted for integrated urban counties (p < 0.0001, 95% CI [3.824, 7.699]). Rural ECE facilities in African American segregated counties were nine times more likely to be at risk of high air respiratory toxicant exposure, adjusted for integrated rural counties (p < 0.0001, 95% CI [5.641, 15.928]). CONCLUSION We found geographically and socially disparate patterns of higher exposures to ambient air respiratory toxicants at Oklahoma ECE facilities. Safer siting policies and interventions are needed to mitigate air respiratory toxicant exposures, which may help to reduce asthma control disparities and improve respiratory health outcomes in Oklahoma ECE facilities.
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Affiliation(s)
- Cassandra D Querdibitty
- Department of Health Promotion Sciences, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA; Oklahoma Area Tribal Epidemiology Center, Southern Plains Tribal Health Board, Oklahoma City, OK, USA.
| | - Janis Campbell
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Marianna S Wetherill
- Department of Health Promotion Sciences, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Alicia L Salvatore
- Department of Health Promotion Sciences, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA; Institute for Research on Equity and Community Health (iREACH), Christiana Care, Wilmington, DE, USA; Department of Human Development and Family Sciences, University of Delaware, Newark, DE, USA.
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Di Ciaula A, Moshammer H, Lauriola P, Portincasa P. Environmental health, COVID-19, and the syndemic: internal medicine facing the challenge. Intern Emerg Med 2022; 17:2187-2198. [PMID: 36181580 PMCID: PMC9525944 DOI: 10.1007/s11739-022-03107-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 09/16/2022] [Indexed: 11/29/2022]
Abstract
Internists are experts in complexity, and the COVID-19 pandemic is disclosing complex and unexpected interactions between communicable and non-communicable diseases, environmental factors, and socio-economic disparities. The medicine of complexity cannot be limited to facing comorbidities and to the clinical management of multifaceted diseases. Evidence indicates how climate change, pollution, demographic unbalance, and inequalities can affect the spreading and outcomes of COVID-19 in vulnerable communities. These elements cannot be neglected, and a wide view of public health aspects by a "one-health" approach is strongly and urgently recommended. According to World Health Organization, 35% of infectious diseases involving the lower respiratory tract depend on environmental factors, and infections from SARS-Cov-2 is not an exception. Furthermore, environmental pollution generates a large burden of non-communicable diseases and disabilities, increasing the individual vulnerability to COVID-19 and the chance for the resilience of large communities worldwide. In this field, the awareness of internists must increase, as privileged healthcare providers. They need to gain a comprehensive knowledge of elements characterizing COVID-19 as part of a syndemic. This is the case when pandemic events hit vulnerable populations suffering from the increasing burden of chronic diseases, disabilities, and social and economic inequalities. Mastering the interplay of such events requires a change in overall strategy, to adequately manage not only the SARS-CoV-2 infection but also the growing burden of non-communicable diseases by a "one health" approach. In this context, experts in internal medicine have the knowledge and skills to drive this change.
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Affiliation(s)
- Agostino Di Ciaula
- Clinica Medica “A. Murri”, Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, Bari, Italy
- International Society of Doctors for Environment (ISDE), Geneva, Switzerland
| | - Hanns Moshammer
- International Society of Doctors for Environment (ISDE), Geneva, Switzerland
- Department of Environmental Health, Center for Public Health, Medical University Vienna, 1090 Vienna, Austria
- Department of Hygiene, Medical University of Karakalpakstan, Nukus, Uzbekistan 230100
| | - Paolo Lauriola
- International Society of Doctors for Environment (ISDE), Geneva, Switzerland
| | - Piero Portincasa
- Clinica Medica “A. Murri”, Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, Bari, Italy
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Zhang Y, Hu H, Fokaidis V, Lewis C, Xu J, Zang C, Xu Z, Wang F, Koropsak M, Bian J, Hall J, Rothman RL, Shenkman EA, Wei WQ, Weiner MG, Carton TW, Kaushal R. Identifying Contextual and Spatial Risk Factors for Post-Acute Sequelae of SARS-CoV-2 Infection: An EHR-based Cohort Study from the RECOVER Program. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2022:2022.10.13.22281010. [PMID: 36263067 PMCID: PMC9580388 DOI: 10.1101/2022.10.13.22281010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Post-acute sequelae of SARS-CoV-2 infection (PASC) affects a wide range of organ systems among a large proportion of patients with SARS-CoV-2 infection. Although studies have identified a broad set of patient-level risk factors for PASC, little is known about the contextual and spatial risk factors for PASC. Using electronic health data of patients with COVID-19 from two large clinical research networks in New York City and Florida, we identified contextual and spatial risk factors from nearly 200 environmental characteristics for 23 PASC symptoms and conditions of eight organ systems. We conducted a two-phase environment-wide association study. In Phase 1, we ran a mixed effects logistic regression with 5-digit ZIP Code tabulation area (ZCTA5) random intercepts for each PASC outcome and each contextual and spatial factor, adjusting for a comprehensive set of patient-level confounders. In Phase 2, we ran a mixed effects logistic regression for each PASC outcome including all significant (false positive discovery adjusted p-value < 0.05) contextual and spatial characteristics identified from Phase I and adjusting for confounders. We identified air toxicants (e.g., methyl methacrylate), criteria air pollutants (e.g., sulfur dioxide), particulate matter (PM 2.5 ) compositions (e.g., ammonium), neighborhood deprivation, and built environment (e.g., food access) that were associated with increased risk of PASC conditions related to nervous, respiratory, blood, circulatory, endocrine, and other organ systems. Specific contextual and spatial risk factors for each PASC condition and symptom were different across New York City area and Florida. Future research is warranted to extend the analyses to other regions and examine more granular contextual and spatial characteristics to inform public health efforts to help patients recover from SARS-CoV-2 infection.
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Affiliation(s)
- Yongkang Zhang
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY
| | - Hui Hu
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Vasilios Fokaidis
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY
| | - Colby Lewis
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY
| | - Jie Xu
- Department of Health Outcomes Biomedical Informatics, University of Florida, Gainesville, FL
| | - Chengxi Zang
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY
| | - Zhenxing Xu
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY
| | - Fei Wang
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY
| | - Michael Koropsak
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY
| | - Jiang Bian
- Department of Health Outcomes Biomedical Informatics, University of Florida, Gainesville, FL
| | - Jaclyn Hall
- Department of Health Outcomes Biomedical Informatics, University of Florida, Gainesville, FL
| | - Russell L Rothman
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | - Elizabeth A Shenkman
- Department of Health Outcomes Biomedical Informatics, University of Florida, Gainesville, FL
| | - Wei-Qi Wei
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN
| | - Mark G Weiner
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY
| | | | - Rainu Kaushal
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY
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Vila D, J McDermott TK. On the frontlines : An exploratory analysis of unequal exposure to air pollution and COVID-19 in the United States. Int J Equity Health 2022; 21:105. [PMID: 35927667 PMCID: PMC9351071 DOI: 10.1186/s12939-022-01705-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 07/19/2022] [Indexed: 11/10/2022] Open
Abstract
Recent literature has suggested a link between poor air quality and worse COVID-19 outcomes. In the United States, this link is particularly noteworthy because of residential sorting along ethnic lines within the US population; minorities are disproportionately exposed to health hazards, including air pollution. The impacts of the COVID-19 pandemic have also been disproportionately concentrated amongst minorities. We explore the association between air quality and COVID-19 outcomes, using county level data for the United States from the first wave of the pandemic in 2020, and test whether exposure to more polluted air can account for some of the observed disparities in COVID-19 outcomes among minorities.
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Affiliation(s)
- Daniel Vila
- Centre for Economic Research on Inclusivity and Sustainability (CERIS) J.E. Cairnes School of Business and Economics, National University of Ireland Galway, Galway, Ireland.
| | - Thomas K J McDermott
- Centre for Economic Research on Inclusivity and Sustainability (CERIS) J.E. Cairnes School of Business and Economics, National University of Ireland Galway, Galway, Ireland
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Xu C, Zhang Z, Ling G, Wang G, Wang M. Air pollutant spatiotemporal evolution characteristics and effects on human health in North China. CHEMOSPHERE 2022; 294:133814. [PMID: 35120956 DOI: 10.1016/j.chemosphere.2022.133814] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 01/18/2022] [Accepted: 01/28/2022] [Indexed: 06/14/2023]
Abstract
North China, the political, economic, and cultural center of China, has been greatly harmed by frequent air pollution incidents. Therefore, it is vital to study air pollution characteristics and clarify their impact on human health. In this study, we first analyzed the spatiotemporal variations of air pollutants (PM2.5, PM10, CO, SO2, NO2, and O3) in North China from 2016 to 2019. Then, the air quality index (AQI), aggregate air quality index (AAQI), and health risk based air quality index (HAQI) were used to assess health risks. Based on these, the AirQ2.2.3 model was used to quantify health effects. The results showed that the major pollutant in the cities surrounding Beijing was PM2.5, while PM10 dominated in distant cities. Annual concentrations decreased (except for O3), which is related to governmental emission reduction policies. However, O3 concentrations increased owing to the complex precursor emissions. The AQI underestimated air pollution, while the AAQI and HAQI were accurate; the latter indicated that 55% of the study region population was exposed to polluted air. The AirQ2.2.3 model quantified the total mortality proportions attributable to PM2.5, PM10, SO2, CO, NO2, and O3, which were 1.87%, 3.12%, 1.11%, 1.40%, 4.19%, and 2.52%, respectively. In high concentrations, PM10 and PM2.5 pose significant health risks. The health effects of SO2, NO2, CO, and O3 at lower concentrations were more obvious, indicating that the expected mortality rate due to low concentrations of some pollutants was much higher than that due to high concentrations of other pollutants.
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Affiliation(s)
- Chuanqi Xu
- College of Geographical Science, Shanxi Normal University, Linfeng, 041000, China; Gansu Key Laboratory for Environmental Pollution Prediction and Control, College of Earth and Environmental Sciences, Lanzhou University, Lanzhou, 730000, China.
| | - Zhi Zhang
- School of Ecology and Environment, YuZhang Normal University, Nanchang, 330022, China
| | - Guangjiu Ling
- School of Tourism and Resource Environment, Qiannan Normal University for Nationalities, Duyun, 558000, China
| | - Guoqiang Wang
- College of Geographical Science, Shanxi Normal University, Linfeng, 041000, China
| | - Mingzhu Wang
- School of Geographical Sciences, East China Normal University, Shanghai, 200241, China
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Prinz AL, Richter DJ. Long-term exposure to fine particulate matter air pollution: An ecological study of its effect on COVID-19 cases and fatality in Germany. ENVIRONMENTAL RESEARCH 2022; 204:111948. [PMID: 34464613 PMCID: PMC8400616 DOI: 10.1016/j.envres.2021.111948] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 08/20/2021] [Accepted: 08/20/2021] [Indexed: 05/18/2023]
Abstract
BACKGROUND COVID-19 is a lung disease, and there is medical evidence that air pollution is one of the external causes of lung diseases. Fine particulate matter is one of the air pollutants that damages pulmonary tissue. The combination of the coronavirus and fine particulate matter air pollution may exacerbate the coronavirus' effect on human health. RESEARCH QUESTION This paper considers whether the long-term concentration of fine particulate matter of different sizes changes the number of detected coronavirus infections and the number of COVID-19 fatalities in Germany. STUDY DESIGN Data from 400 German counties for fine particulate air pollution from 2002 to 2020 are used to measure the long-term impact of air pollution. Kriging interpolation is applied to complement data gaps. With an ecological study, the correlation between average particulate matter air pollution and COVID-19 cases, as well as fatalities, are estimated with OLS regressions. Thereby, socioeconomic and demographic covariates are included. MAIN FINDINGS An increase in the average long-term air pollution of 1 μg/m3 particulate matter PM2.5 is correlated with 199.46 (SD = 29.66) more COVID-19 cases per 100,000 inhabitants in Germany. For PM10 the respective increase is 52.38 (SD = 12.99) more cases per 100,000 inhabitants. The number of COVID-19 deaths were also positively correlated with PM2.5 and PM10 (6.18, SD = 1.44, respectively 2.11, SD = 0.71, additional COVID-19 deaths per 100,000 inhabitants). CONCLUSION Long-term fine particulate air pollution is suspected as causing higher numbers of COVID-19 cases. Higher long-term air pollution may even increase COVID-19 death rates. We find that the results of the correlation analysis without controls are retained in a regression analysis with controls for relevant confounding factors. Nevertheless, additional epidemiological investigations are required to test the causality of particulate matter air pollution for COVID-19 cases and the severity.
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Affiliation(s)
- Aloys L Prinz
- Institute of Public Economics, University of Muenster, Wilmergasse 6-8, 48143, Muenster, Germany.
| | - David J Richter
- Institute of Public Economics, University of Muenster, Wilmergasse 6-8, 48143, Muenster, Germany.
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Bakshi A, Van Doren A, Maser C, Aubin K, Stewart C, Soileau S, Friedman K, Williams A. Identifying Louisiana communities at the crossroads of environmental and social vulnerability, COVID-19, and asthma. PLoS One 2022; 17:e0264336. [PMID: 35196332 PMCID: PMC8865632 DOI: 10.1371/journal.pone.0264336] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 02/08/2022] [Indexed: 12/23/2022] Open
Abstract
The COVID-19 pandemic has disproportionately affected the socially and environmentally vulnerable, including through indirect effects on other health conditions. Asthma is one such condition, which may be exacerbated by both prolonged adverse in-home exposures if quarantining in unhealthy homes and prolonged outdoor exposures if the ambient air quality is unhealthy or hazardous. As both are often the case in Environmental Justice (EJ) communities, here we have analyzed data at the census tract (CT) level for Louisiana to assess any correlation between social and environmental vulnerability, and health issues like COVID-19 and asthma. Higher Social Vulnerability Index (SVI), Particulate Matter less than 2.5 μm in diameter (PM2.5) and Ozone levels were associated with higher rates of cumulative COVID-19 incidence at various time points during the pandemic, as well as higher average annual asthma hospitalization rates and estimated asthma prevalence. Further, cumulative COVID-19 incidence during the first three months of the pandemic was moderately correlated with both asthma hospitalizations and estimated prevalence, suggesting similar underlying factors may be affecting both conditions. Additionally, 137 CTs were identified where social and environmental vulnerabilities co-existed, of which 75 (55%) had high estimated prevalence of asthma. These areas are likely to benefit from asthma outreach that considers both social and environmental risk factors. Fifteen out of the 137 CTs (11%) not only had higher estimated prevalence of asthma but also a high burden of COVID-19. Further research in these areas may help to elucidate any common social determinants of health that underlie both asthma and COVID-19 burdens, as well as better clarify the possible role of the environment as related to the COVID-19 burden in Louisiana.
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Affiliation(s)
- Arundhati Bakshi
- Section of Environmental Epidemiology and Toxicology, Office of Public Health, Louisiana Department of Health, Baton Rouge, Louisiana, United States of America
| | - Alicia Van Doren
- Section of Environmental Epidemiology and Toxicology, Office of Public Health, Louisiana Department of Health, Baton Rouge, Louisiana, United States of America
| | - Colette Maser
- Section of Environmental Epidemiology and Toxicology, Office of Public Health, Louisiana Department of Health, Baton Rouge, Louisiana, United States of America
| | - Kathleen Aubin
- Section of Environmental Epidemiology and Toxicology, Office of Public Health, Louisiana Department of Health, Baton Rouge, Louisiana, United States of America
| | - Collette Stewart
- Section of Environmental Epidemiology and Toxicology, Office of Public Health, Louisiana Department of Health, Baton Rouge, Louisiana, United States of America
| | - Shannon Soileau
- Section of Environmental Epidemiology and Toxicology, Office of Public Health, Louisiana Department of Health, Baton Rouge, Louisiana, United States of America
| | - Kate Friedman
- Section of Environmental Epidemiology and Toxicology, Office of Public Health, Louisiana Department of Health, Baton Rouge, Louisiana, United States of America
| | - Alexis Williams
- Section of Environmental Epidemiology and Toxicology, Office of Public Health, Louisiana Department of Health, Baton Rouge, Louisiana, United States of America
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Milicevic O, Salom I, Rodic A, Markovic S, Tumbas M, Zigic D, Djordjevic M, Djordjevic M. PM 2.5 as a major predictor of COVID-19 basic reproduction number in the USA. ENVIRONMENTAL RESEARCH 2021; 201:111526. [PMID: 34174258 PMCID: PMC8223012 DOI: 10.1016/j.envres.2021.111526] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 06/05/2021] [Accepted: 06/09/2021] [Indexed: 05/04/2023]
Abstract
Many studies have proposed a relationship between COVID-19 transmissibility and ambient pollution levels. However, a major limitation in establishing such associations is to adequately account for complex disease dynamics, influenced by e.g. significant differences in control measures and testing policies. Another difficulty is appropriately controlling the effects of other potentially important factors, due to both their mutual correlations and a limited dataset. To overcome these difficulties, we will here use the basic reproduction number (R0) that we estimate for USA states using non-linear dynamics methods. To account for a large number of predictors (many of which are mutually strongly correlated), combined with a limited dataset, we employ machine-learning methods. Specifically, to reduce dimensionality without complicating the variable interpretation, we employ Principal Component Analysis on subsets of mutually related (and correlated) predictors. Methods that allow feature (predictor) selection, and ranking their importance, are then used, including both linear regressions with regularization and feature selection (Lasso and Elastic Net) and non-parametric methods based on ensembles of weak-learners (Random Forest and Gradient Boost). Through these substantially different approaches, we robustly obtain that PM2.5 is a major predictor of R0 in USA states, with corrections from factors such as other pollutants, prosperity measures, population density, chronic disease levels, and possibly racial composition. As a rough magnitude estimate, we obtain that a relative change in R0, with variations in pollution levels observed in the USA, is typically ~30%, which further underscores the importance of pollution in COVID-19 transmissibility.
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Affiliation(s)
- Ognjen Milicevic
- Department for Medical Statistics and Informatics, School of Medicine, University of Belgrade, Serbia
| | - Igor Salom
- Institute of Physics Belgrade, National Institute of the Republic of Serbia, University of Belgrade, Serbia
| | - Andjela Rodic
- Quantitative Biology Group, Institute of Physiology and Biochemistry, Faculty of Biology, University of Belgrade, Serbia
| | - Sofija Markovic
- Quantitative Biology Group, Institute of Physiology and Biochemistry, Faculty of Biology, University of Belgrade, Serbia
| | - Marko Tumbas
- Quantitative Biology Group, Institute of Physiology and Biochemistry, Faculty of Biology, University of Belgrade, Serbia
| | - Dusan Zigic
- Institute of Physics Belgrade, National Institute of the Republic of Serbia, University of Belgrade, Serbia
| | - Magdalena Djordjevic
- Institute of Physics Belgrade, National Institute of the Republic of Serbia, University of Belgrade, Serbia
| | - Marko Djordjevic
- Quantitative Biology Group, Institute of Physiology and Biochemistry, Faculty of Biology, University of Belgrade, Serbia.
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12
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Balmes JR. Stress Is in the Air: Ambient Reactive Oxygen Species and COVID-19. Am J Respir Crit Care Med 2021; 204:118-120. [PMID: 34038698 PMCID: PMC8650787 DOI: 10.1164/rccm.202104-1041ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
- John R Balmes
- Department of Medicine University of California, San Francisco San Francisco, California.,School of Public Health University of California, Berkeley Berkeley, California
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13
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Younis JS, Skorecki K, Abassi Z. The Double Edge Sword of Testosterone's Role in the COVID-19 Pandemic. Front Endocrinol (Lausanne) 2021; 12:607179. [PMID: 33796068 PMCID: PMC8009245 DOI: 10.3389/fendo.2021.607179] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 01/19/2021] [Indexed: 01/08/2023] Open
Abstract
COVID-19 is a complex disease with a multifaceted set of disturbances involving several mechanisms of health and disease in the human body. Sex hormones, estrogen, and testosterone, seem to play a major role in its pathogenesis, development, spread, severity, and mortalities. Examination of factors such as age, gender, ethnic background, genetic prevalence, and existing co-morbidities, may disclose the mechanisms underlying SARS-CoV-2 infection, morbidity, and mortality, paving the way for COVID-19 amelioration and substantial flattening of the infection curve. In this mini-review, we focus on the role of testosterone through a discussion of the intricate mechanisms of disease development and deterioration. Accumulated evidence suggests that there are links between high level (normal male level) as well as low level (age-related hypogonadism) testosterone in disease progression and expansion, supporting its role as a double-edged sword. Unresolved questions point to the essential need for further targeted studies to substantiate these contrasting mechanisms.
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Affiliation(s)
- Johnny S. Younis
- Reproductive Medicine, Department of Obstetrics and Gynecology, Baruch Padeh Medical Center, Poriya, Israel
- Azrieili Faculty of Medicine in Galilee, Bar-Ilan University, Safed, Israel
- *Correspondence: Johnny S. Younis,
| | - Karl Skorecki
- Azrieili Faculty of Medicine in Galilee, Bar-Ilan University, Safed, Israel
| | - Zaid Abassi
- Department of Physiology, Rappaport Faculty of Medicine, Technion, Haifa, Israel
- Laboratory Medicine, Rambam Health Care Campus, Haifa, Israel
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