Anneser Elyssa, Stopka Thomas J, Naumova Elena N, Spangler Keith R, Lane Kevin J, Acevedo Andrea, Griffiths Jeffrey K, Lin Yan, Levine Peter, Corlin Laura
Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA.
Tufts Clinical and Translational Sciences Institute, Boston, MA, USA.
medRxiv. 2023 May 17:2023.05.16.23290050. doi: 10.1101/2023.05.16.23290050.
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/m; 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.
某些环境暴露因素，如空气污染，与新冠病毒疾病（COVID-19）的发病率和死亡率相关。为了确定环境背景是否与其他COVID-19经历相关，我们使用了具有全国代表性的塔夫茨健康、财富和公民参与公平性研究数据（n = 1785；2020 - 2022年的三轮调查）。环境背景通过自我报告的气候压力以及县级空气污染、绿化程度、有毒物质排放清单站点和热浪数据进行评估。自我报告的COVID-19经历包括接种COVID-19疫苗的意愿、COVID-19对健康的影响、获得COVID-19援助以及提供COVID-19援助。2020年或2021年自我报告的气候压力与到2022年COVID-19疫苗接种意愿增加相关（优势比[OR] = 2.35；95%置信区间[CI] = 1.47，3.76），即使在调整政治派别后（OR = 1.79；95% CI = 1.09，2.93）。2020年自我报告的气候压力也与到2021年获得COVID-19援助的可能性增加相关（OR = 1.89；95% CI = 1.29，2.78）。县级暴露因素（即绿化程度较低、有毒物质排放清单站点较多、热浪较多）与疫苗接种意愿增加相关。2020年的空气污染暴露与2020年提供COVID-19援助的可能性呈正相关（每微克/立方米的OR = 1.16；95% CI = 1.02，1.32）。在那些非西班牙裔白人以外的种族/族裔身份者以及报告经历过歧视的人群中，某些环境暴露与某些COVID-19结果之间的关联更强；然而，这些趋势并不一致。一个代表环境背景汇总结构的潜在变量与COVID-19疫苗接种意愿相关。我们的研究结果进一步丰富了越来越多的文献，表明影响暴露于不利环境条件可能性的交叉公平问题也与健康相关结果有关。
