Department of City and Metropolitan Planning, The University of Utah, Salt Lake City, Utah, United States of America.
Department of Urban and Regional Planning, University of Colorado Denver, Denver, Colorado, United States of America.
PLoS One. 2023 Jun 14;18(6):e0286119. doi: 10.1371/journal.pone.0286119. eCollection 2023.
Research on the associations between the built environment and COVID-19 outcomes has mostly focused on incidence and mortality. Also, few studies on the built environment and COVID-19 have controlled for individual-level characteristics across large samples. In this study, we examine whether neighborhood built environment characteristics are associated with hospitalization in a cohort of 18,042 individuals who tested positive for SARS-CoV-2 between May and December 2020 in the Denver metropolitan area, USA. We use Poisson models with robust standard errors that control for spatial dependence and several individual-level demographic characteristics and comorbidity conditions. In multivariate models, we find that among individuals with SARS-CoV-2 infection, those living in multi-family housing units and/or in places with higher particulate matter (PM2.5) have a higher incident rate ratio (IRR) of hospitalization. We also find that higher walkability, higher bikeability, and lower public transit access are linked to a lower IRR of hospitalization. In multivariate models, we did not find associations between green space measures and the IRR of hospitalization. Results for non-Hispanic white and Latinx individuals highlight substantial differences: higher PM2.5 levels have stronger positive associations with the IRR of hospitalization for Latinx individuals, and density and overcrowding show stronger associations for non-Hispanic white individuals. Our results show that the neighborhood built environment might pose an independent risk for COVID-19 hospitalization. Our results may inform public health and urban planning initiatives to lower the risk of hospitalization linked to COVID-19 and other respiratory pathogens.
关于建筑环境与 COVID-19 结局之间关联的研究主要集中在发病率和死亡率上。此外，关于建筑环境与 COVID-19 的研究很少在大样本中控制个体水平特征。在这项研究中，我们研究了在 2020 年 5 月至 12 月期间，在美国丹佛大都市区检测出 SARS-CoV-2 呈阳性的 18042 名个体中，邻里建筑环境特征是否与住院相关。我们使用泊松模型和稳健标准误差来控制空间依赖性和几个个体水平的人口统计学特征和合并症条件。在多变量模型中，我们发现，在感染 SARS-CoV-2 的个体中，居住在多户住宅单元中和/或居住在细颗粒物（PM2.5）较高的地方的个体，其住院的发生率比（IRR）更高。我们还发现，步行性更高、自行车骑行性更高和公共交通可达性更低与住院的 IRR 降低相关。在多变量模型中，我们没有发现绿地措施与住院的 IRR 之间存在关联。非西班牙裔白人和拉丁裔个体的结果突出了显著差异：PM2.5 水平较高与拉丁裔个体住院的 IRR 呈更强的正相关，而密度和过度拥挤与非西班牙裔白人个体的关联更强。我们的研究结果表明，邻里建筑环境可能对 COVID-19 住院构成独立风险。我们的研究结果可能为公共卫生和城市规划计划提供信息，以降低与 COVID-19 和其他呼吸道病原体相关的住院风险。
