Kannoth Sneha, Zhang Cong, Shafiq Mehr, Albrecht Sandra S, Azan Alexander, Chambers Earle C, Qian Min, Sheffield Perry E, Thompson Azure, Woo Baidal Jennifer A, Lovinsky-Desir Stephanie, Stingone Jeanette A
Columbia University, Mailman School of Public Health, New York, NY, USA.
Columbia University, Mailman School of Public Health, New York, NY, USA.
Environ Int. 2025 Aug;202:109660. doi: 10.1016/j.envint.2025.109660. Epub 2025 Jul 2.
Communities disproportionately burdened by adverse neighborhood-level social and structural factors may experience greater vulnerability to environmental exposures, contributing to health inequities, including adverse COVID-19. We assessed the effects of chronic air pollution on COVID-19 morbidities in NYC and examined whether these effects varied by neighborhood-level vulnerability.
We used NYC COVID-19 hospitalization records (3/1/2020-2/28/2021) and conducted analyses in the full sample and within hospital catchment. Chronic air pollution (particulate matter (PM), nitrogen dioxide (NO), black carbon (BC), ozone (O)) was assigned using residential ZIP Code (NYC Community Air Survey; 2009-2019). Modified Poisson regression estimated risk of acute respiratory distress syndrome (ARDS), pneumonia, ventilation, and dialysis, and Cox regression estimated risk of discharge, adjusting for age, sex, BMI, smoking, asthma, diabetes, and hypertension. We assessed effect modification by neighborhood-level environmental vulnerability index (NEVI) tertiles.
From March to June 2020 (within hospital catchment), adjusted estimates generally suggest greater chronic NO, PM, and BC was associated with increased risk of ARDS, pneumonia, and dialysis, and not associated with discharge and ventilation; inverse estimates found for chronic O. Relationships between air pollution and adverse COVID-19 were generally stronger among those with greater neighborhood environmental vulnerability. For example, chronic NO and pneumonia's relationship was stronger in individuals within higher NEVI tertiles (T1: aRR: 1.13, 95%CI: 1.02-1.25; T2: aRR: 2.11, 95%CI: 1.73-2.56; T3: aRR: 6.36, 95%CI: 4.71-8.60).
Differences in neighborhood-level social and structural factors contribute to unequal health burdens associated with air pollution. Public health resources targeted toward neighborhoods with greater environmental vulnerability can encourage population-level pandemic preparedness.
受邻里层面不利社会和结构因素影响尤甚的社区，可能更容易受到环境暴露的影响，进而导致健康不平等，包括感染新冠病毒后的不良后果。我们评估了纽约市慢性空气污染对新冠病毒感染相关疾病的影响，并研究了这些影响是否因邻里层面的脆弱性而异。
我们使用了纽约市新冠病毒感染住院记录（2020年3月1日至2021年2月28日），并在全样本以及医院服务区域内进行了分析。慢性空气污染（颗粒物（PM）、二氧化氮（NO）、黑碳（BC）、臭氧（O））通过居民邮政编码进行赋值（纽约市社区空气调查；2009 - 2019年）。修正泊松回归估计急性呼吸窘迫综合征（ARDS）、肺炎、通气和透析的风险，Cox回归估计出院风险，并对年龄、性别、体重指数、吸烟、哮喘、糖尿病和高血压进行了调整。我们通过邻里层面环境脆弱性指数（NEVI）三分位数评估效应修饰。
在2020年3月至6月期间（医院服务区域内），调整后的估计结果总体表明，更高的慢性NO、PM和BC与ARDS、肺炎和透析风险增加相关，与出院和通气无关；慢性O则呈现相反的估计结果。空气污染与新冠病毒感染不良后果之间的关系，在邻里环境脆弱性较高的人群中通常更强。例如，慢性NO与肺炎的关系在NEVI三分位数较高的个体中更强（T1：调整后风险比（aRR）：1.13，95%置信区间（CI）：1.02 - 1.25；T2：aRR：2.11，95%CI：1.73 - 2.56；T3：aRR：6.36，95%CI：4.71 - 8.60）。
邻里层面社会和结构因素的差异导致了与空气污染相关的不平等健康负担。针对环境脆弱性较高社区的公共卫生资源，可以促进人群层面的疫情防范。
