Multilevel Analysis of Racial and Ethnic Disparities in COVID-19 Hospitalization among Children with Allergies.

Rationale: Previous studies have identified risk factors for coronavirus disease (COVID-19) hospitalization in children. However, these studies have been limited in their ability to disentangle the contribution of racial disparities, allergic comorbidities, and environmental exposures to the development of severe COVID-19 in at-risk children with allergies. Objectives: To examine racial and ethnic disparities in COVID-19 hospitalization and their links to potentially underlying allergic comorbidities and individual and place-based factors in children with allergies. Methods: This is an electronic health record-based retrospective study of children in 2020. The outcome was COVID-19 hospitalization categorized as no hospital care for patients with asymptomatic/mild illness, short stay for patients admitted and discharged within 24 hours, and prolonged stay for patients requiring additional time to discharge (more than 24 h). Mixed-effects and mediation models were used to determine relationships among independent variables, mediators, and COVID-19 hospitalization. Results: Among the 5,258 children with COVID-19 positive test or diagnosis, 10% required a short stay, and 3.7% required a prolonged stay. Black and Hispanic children had higher odds of longer stays than non-Hispanic White children (both P < 0.001). Children with obesity and eosinophilic esophagitis diagnoses had higher odds of short and prolonged stay (all P < 0.05). Area-level deprivation was associated with short stay (adjusted odds ratio [AOR], 15.49; 95% confidence interval [CI], 5.16-45.47 for every 0.1-unit increase) and prolonged stay (AOR, 11.82; 95% CI, 2.25-62.01 for every 0.1-unit increase). Associations between race/ethnicity and COVID-19 hospitalization were primarily mediated by insurance and area-level deprivation, altogether accounting for 99% of the variation in COVID-19 hospitalization. Conclusions: There were racial and ethnic differences in children with allergies and individual and place-based factors related to COVID-19 hospitalization. Differences were primarily mediated by insurance and area-level deprivation, altogether accounting for 99% of the variation in COVID-19 hospitalization. A better understanding of COVID-related morbidity in children and the link to place-based factors is key to developing prevention strategies capable of equitably improving outcomes.

Air pollution and the pandemic: Long-term PM2.5 exposure and disease severity in COVID-19 patients.

BACKGROUND AND OBJECTIVE: Ecological studies have suggested an association between exposure to particulate matter ≤2.5 µm (PM2.5 ) and coronavirus disease 2019 (COVID-19) severity. However, these findings are yet to be validated in individual-level studies. We aimed to determine the association of long-term PM2.5 exposure with hospitalization among individual patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). METHODS: We estimated the 10-year (2009-2018) PM2.5 exposure at the residential zip code of COVID-19 patients diagnosed at the University of Cincinnati healthcare system between 13 March 2020 and 30 September 2020. Logistic regression was used to determine the odds ratio (OR) and 95% CI for COVID-19 hospitalizations associated with PM2.5 , adjusting for socioeconomic characteristics and comorbidities. RESULTS: Among the 14,783 COVID-19 patients included in our study, 13.6% were hospitalized; the geometric mean (SD) PM2.5 was 10.48 (1.12) µg/m3 . In adjusted analysis, 1 µg/m3 increase in 10-year annual average PM2.5 was associated with 18% higher hospitalization (OR: 1.18, 95% CI: 1.11-1.26). Likewise, 1 µg/m3 increase in PM2.5 estimated for the year 2018 was associated with 14% higher hospitalization (OR: 1.14, 95% CI: 1.08-1.21). CONCLUSION: Long-term PM2.5 exposure is associated with increased hospitalization in COVID-19. Therefore, more stringent COVID-19 prevention measures may be needed in areas with higher PM2.5 exposure to reduce the disease morbidity and healthcare burden.

Environmental Determinants of Coronavirus Disease 2019 (COVID-19).

PURPOSE FOR REVIEW: Since the coronavirus SARS-CoV-2 outbreak in China in late 2019 turned into a global pandemic, numerous studies have reported associations between environmental factors, such as weather conditions and a range of air pollutants (particulate matter, nitrogen dioxide, ozone, etc.) and the first wave of COVID-19 cases. This review aims to offer a critical assessment of the role of environmental exposure risk factors on SARS-CoV-2 infections and COVID-19 disease severity. RECENT FINDINGS: In this review, we provide a critical assessment of COVID-19 risk factors, identify gaps in our knowledge (e.g., indoor air pollution), and discuss methodological challenges of association and causation and the impact lockdowns had on air quality. In addition, we will draw attention to ethnic and socioeconomic factors driving viral transmission related to COVID-19. The complex role angiotensin-converting enzyme 2 (ACE2) plays in COVID-19 and future promising avenues of research are discussed. To demonstrate causality, we stress the need for future epidemiologic studies integrating personal air pollution exposures, detailed clinical COVID-19 data, and a range of socioeconomic factors, as well as in vitro and in vivo mechanistic studies.

Long-term exposure to fine particulate matter and hospitalization in COVID-19 patients.

BACKGROUND: Ecological evidence suggests that exposure to air pollution affects coronavirus disease 2019 (COVID-19) outcomes. However, no individual-level study has confirmed the association to date. METHODS: We identified COVID-19 patients diagnosed at the University of Cincinnati hospitals and clinics and estimated particulate matter ≤2.5 µm (PM2.5) exposure over a 10-year period (2008-2017) at their residential zip codes. We used logistic regression to evaluate the association between PM2.5 exposure and hospitalizations for COVID-19, adjusting for socioeconomic characteristics and comorbidities. RESULTS: Among the 1128 patients included in our study, the mean (standard deviation) PM2.5 was 11.34 (0.70) µg/m3 for the 10-year average exposure and 13.83 (1.03) µg/m3 for the 10-year maximal exposures. The association between long-term PM2.5 exposure and hospitalization for COVID-19 was contingent upon having pre-existing asthma or chronic obstructive pulmonary (COPD) (Pinteraction = 0.030 for average PM2.5 and Pinteraction = 0.001 for maximal PM2.5). In COVID-19 patients with asthma or COPD, the odds of hospitalization were 62% higher with 1 µg/m3 increment in 10-year average PM2.5 (odds ratio [OR]: 1.62, 95% confidence interval [CI]: 1.00-2.64) and 65% higher with 1 µg/m3 increase in 10-year maximal PM2.5 levels (OR: 1.65, 95% CI: 1.16-2.35). However, among COVID-19 patients without asthma or COPD, PM2.5 exposure was not associated with higher hospitalizations (OR: 0.84, 95% CI: 0.65-1.09 for average PM2.5 and OR: 0.78, 95% CI: 0.65-0.95 for maximal PM2.5). CONCLUSIONS: Long-term exposure to PM2.5 is associated with higher odds of hospitalization in COVID-19 patients with pre-existing asthma or COPD.