Zhang Yongkang, Hu Hui, Fokaidis Vasilios, V Colby Lewis, Xu Jie, Zang Chengxi, Xu Zhenxing, Wang Fei, Koropsak Michael, Bian Jiang, Hall Jaclyn, Rothman Russell L, Shenkman Elizabeth A, Wei Wei-Qi, Weiner Mark G, Carton Thomas W, Kaushal Rainu
Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, United States.
Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States.
Environ Adv. 2023 Apr;11:100352. doi: 10.1016/j.envadv.2023.100352. Epub 2023 Feb 8.
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 association between "exposome"-the totality of environmental exposures and the risk of PASC. Using electronic health data of patients with COVID-19 from two large clinical research networks in New York City and Florida, we identified environmental risk factors for 23 PASC symptoms and conditions from nearly 200 exposome factors. The three domains of exposome include natural environment, built environment, and social environment. 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 exposome 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) exposome characteristics identified from Phase I and adjusting for confounders. We identified air toxicants (e.g., methyl methacrylate), particulate matter (PM) 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, blood, circulatory, endocrine, and other organ systems. Specific environmental risk factors for each PASC condition and symptom were different across the New York City area and Florida. Future research is warranted to extend the analyses to other regions and examine more granular exposome characteristics to inform public health efforts to help patients recover from SARS-CoV-2 infection.
2019冠状病毒病感染的急性后遗症(PASC)在很大一部分2019冠状病毒病感染患者中影响着广泛的器官系统。尽管研究已经确定了一系列广泛的PASC患者层面的风险因素,但对于“暴露组”(即环境暴露的总和)与PASC风险之间的关联却知之甚少。利用来自纽约市和佛罗里达州两个大型临床研究网络的新冠肺炎患者的电子健康数据,我们从近200个暴露组因素中确定了23种PASC症状和病症的环境风险因素。暴露组的三个领域包括自然环境、建筑环境和社会环境。我们进行了两阶段的全环境关联研究。在第一阶段,我们针对每个PASC结局和每个暴露组因素,运行了一个具有5位邮政编码分区(ZCTA5)随机截距的混合效应逻辑回归,并对一系列全面的患者层面混杂因素进行了调整。在第二阶段,我们针对每个PASC结局运行了一个混合效应逻辑回归,包括从第一阶段确定的所有显著(错误发现率调整p值<0.05)的暴露组特征,并对混杂因素进行了调整。我们确定了与神经、血液、循环、内分泌和其他器官系统相关的PASC病症风险增加有关的空气有毒物质(如甲基丙烯酸甲酯)、颗粒物(PM)成分(如铵)、社区贫困和建筑环境(如食物获取)。纽约市地区和佛罗里达州每个PASC病症和症状的具体环境风险因素各不相同。有必要开展进一步研究,将分析扩展到其他地区,并研究更细致的暴露组特征,以为公共卫生工作提供信息,帮助患者从2019冠状病毒病感染中康复。