The neighborhood built environment and COVID-19 hospitalizations
Alessandro Rigolon, Jeremy Németh, Brenn Anderson-Gregson, Ana Rae Miller, Priyanka Desouza, Brian Montague, Cory Hussain, Kristine M Erlandson, Sarah E Rowan
PLOS ONE, doi:10.1371/journal.pone.0286119
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 (PM 2.5 ) 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 PM 2.5 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.
Supporting information
S1 Appendix. (DOCX)
Author Contributions
References
Anguelovski, Triguero-Mas, Connolly, Kotsila, Shokry et al., Gentrification and health in two global cities: A call to identify impacts for socially-vulnerable residents, Cities Heal,
doi:10.1080/23748834.2019.1636507
Baden, Sahly, Essink, Kotloff, Frey et al., Efficacy and safety of the mRNA-1273 SARS-CoV-2 vaccine, N Engl J Med,
doi:10.1056/NEJMoa2035389
Barajas, Biking where Black: Connecting transportation planning and infrastructure to disproportionate policing, Transp Res Part D Transp Environ,
doi:10.1016/j.trd.2021.103027
Bell, Ebisu, Environmental inequality in exposures to airborne particulate matter components in the United States. Environ Heal Perpsectives,
doi:10.1289/ehp.1205201
Boterman, Urban-rural polarisation in times of the Corona outbreak? The early demographic and geographic patterns of the SARS-CoV-2 epidemic in the Netherlands, Tijdschr voor Econ en Soc Geogr,
doi:10.1111/tesg.12437
Bowe, Xie, Gibson, Cai, Van Donkelaar et al., Ambient fine particulate matter air pollution and the risk of hospitalization among COVID-19 positive individuals: Cohort study, Environ Int,
doi:10.1016/j.envint.2021.106564
Braveman, Cubbin, Egerter, Pedregon, None
Bray, Gibson, White, Coronavirus disease 2019 mortality: A multivariate ecological analysis in relation to ethnicity, population density, obesity, deprivation and pollution, Public Health,
doi:10.1016/j.puhe.2020.06.056
Browning, Rigolon, Could nature help children rise out of poverty? Green space and future earnings from a cohort in ten U.S. cities, Environ Res,
doi:10.1016/j.envres.2019.04.016
Bryan, Sun, Jagai, Horton, Montgomery et al., Coronavirus disease 2019 (COVID-19) mortality and neighborhood characteristics in Chicago, Ann Epidemiol,
doi:10.1016/j.annepidem.2020.10.011
Chakrabarty, Beeler, Liu, Goswami, Harvey et al., Ambient PM2.5 exposure and rapid spread of COVID-19 in the United States, Sci Total Environ,
doi:10.1016/j.scitotenv.2020.143391
Chaturvedi, Vishwakarma, Singh, COVID-19 and its impact on education, social life and mental health of students: A survey, Child Youth Serv Rev,
doi:10.1016/j.childyouth.2020.105866
Chennakesavulu, Reddy, The effect of latitude and PM2.5 on spreading of SARS-CoV-2 in tropical and temperate zone countries, Environ Pollut,
doi:10.1016/j.envpol.2020.115176
Chetty, Hendren, Kline, Saez, Where is the land of opportunity? The geography of intergenerational mobility in the United States, Q J Econ,
doi:10.1093/qje/qju022
Choi, Denice, Haan, Zajacova, Studying the social determinants of COVID-19 in a data vacuum, Can Rev Sociol,
doi:10.1111/cars.12336
Cohen, Brauer, Burnett, Hr, Frostad et al., Estimates and 25-year trends of the global burden of disease attributable to ambient air pollution: an analysis of data from the Global Burden of Diseases Study, Lancet,
doi:10.1016/S0140-6736%2817%2930505-6
Copiello, Grillenzoni, Association between short-term exposure to air pollution and COVID-19 infection: Evidence from China, Zhu et al. Sci Total Environ,
doi:10.1016/j.scitotenv.2020.141028
Credit, Neighbourhood inequity: Exploring the factors underlying racial and ethnic disparities in COVID-19 testing and infection rates using ZIP code data in Chicago and New York, Reg Sci Policy Pract,
doi:10.1111/rsp3.12321
Denver, Health, Center, None
Desouza, Braun, Parks, Schwartz, Dominici et al., Nationwide study of short-term exposure to fine particulate matter and cardiovascular hospitalizations among medicaid enrollees, Epidemiology,
doi:10.1097/EDE.0000000000001265
Dominici, Peng, Bell, Pham, Mcdermott et al., Fine particulate air pollution and hospital admission for cardiovascular and respiratory diseases, J Am Med Assoc,
doi:10.1001/jama.295.10.1127
Drcog, Parks recreation and open space
Faq, None
Field, Discovering statistics using SPSS
Frontera, Cianfanelli, Vlachos, Landoni, Cremona, Severe air pollution links to higher mortality in COVID-19 patients: The "double-hit" hypothesis, J Infect,
doi:10.1016/j.jinf.2020.05.031
Fronza, Lusic, Schmidt, Lucic, Spatial-temporal variations in atmospheric factors contribute to SARS-CoV-2 outbreak, Viruses,
doi:10.3390/v12060588
Frumkin, COVID-19, the built environment, and health. Environ Heal Perpsectives,
doi:10.1289/EHP8888
Gaitens, Condon, Fernandes, Mcdiarmid, COVID-19 and essential workers: A narrative review of health outcomes and moral injury, Int J Environ Res Public Health,
doi:10.3390/ijerph18041446
Goldberg, Security information
Griffith, Spatial autocorrelation and spatial filtering: Gaining understanding through theory and scientific visualization
Hendryx, Luo, COVID-19 prevalence and fatality rates in association with air pollution emission concentrations and emission sources, Environ Pollut,
doi:10.1016/j.envpol.2020.115126
Hernandez, Denver's population grew by more than 115,000 residents in the last decade
Hu, Chen, Who left riding transit? Examining socioeconomic disparities in the impact of COVID-19 on ridership, Transp Res Part D Transp Environ,
doi:10.1016/j.trd.2020.102654
Huang, Kwan, Uncertainties in the assessment of COVID-19 risk: A study of people's exposure to high-risk environments using individual-level activity data, Ann Am Assoc Geogr,
doi:10.1080/24694452.2021.1943301
Jackman, Tahk, Zeileis, Maimone, Fearon et al., None
Kim, Garg, 'halloran, Whitaker, Pham et al., Risk factors for intensive care unit admission and in-hospital mortality among hospitalized adults identified through the US Coronavirus disease 2019 (COVID-19)-Associated hospitalization surveillance network (COVID-NET), Clin Infect Dis,
doi:10.1093/cid/ciaa1012
Klompmaker, Hart, Holland, Sabath, Wu et al., County-level exposures to greenness and associations with COVID-19 incidence and mortality in the United States, Environ Res,
doi:10.1016/j.envres.2021.111331
Knol, Cessie, Algra, Vandenbroucke, Groenwold, Overestimation of risk ratios by odds ratios in trials and cohort studies: Alternatives to logistic regression, C Can Med Assoc J,
doi:10.1503/cmaj.101715
Kodera, Rashed, Hirata, Correlation between COVID-19 morbidity and mortality rates in Japan and local population density, temperature, and absolute humidity, Int J Environ Res Public Health,
doi:10.3390/ijerph17155477
Labib, Browning, Rigolon, Helbich, James, Nature's contributions in coping with a pandemic in the 21st century: A narrative review of evidence during COVID-19, Sci Total Environ,
doi:10.1016/j.scitotenv.2022.155095
Lewis, Friedrichs, Wagstaff, Sage, Lacross et al., Disparities in COVID-19 incidence, hospitalizations, and testing, by area-level deprivation, Morb Mortal Wkly Rep,
doi:10.15585/mmwr.mm6938a4
Liu, Emerging study on the transmission of the Novel Coronavirus (COVID-19) from urban perspective: Evidence from China, Cities,
doi:10.1016/j.cities.2020.102759
Liu, Kwan, Integrated analysis of doubly disadvantaged neighborhoods by considering both green space and blue space accessibility and COVID-19 infection risk, PLoS One,
doi:10.1371/journal.pone.0273125
Lu, Chen, Liu, Yang, Sullivan et al., Green spaces mitigate racial disparity of health: A higher ratio of green spaces indicates a lower racial disparity in SARS-CoV-2 infection rates in the USA, Environ Int,
doi:10.1016/j.envint.2021.106465
Mackey, Ayers, Kondo, Saha, Advani et al., Racial and ethnic disparities in COVID-19-related infections, hospitalizations, and deaths: A systematic review, Ann Intern Med,
doi:10.7326/M20-6306
Markevych, Schoierer, Hartig, Chudnovsky, Hystad et al., Exploring pathways linking greenspace to health: Theoretical and methodological guidance, Environ Res,
doi:10.1016/j.envres.2017.06.028
Maroko, Nash, Pavilonis, Covid-19 and Inequity: A comparative spatial analysis of New York City and Chicago hot spots, J Urban Heal,
doi:10.1007/s11524-020-00468-0
Marquès, Domingo, Positive association between outdoor air pollution and the incidence and severity of COVID-19. A review of the recent scientific evidences, Environ Res,
doi:10.1016/j.envres.2021.111930
Mckibbin, Fernando, The economic impact of COVID-19
Mendy, Wu, Keller, Fassler, Apewokin et al., Long-term exposure to fine particulate matter and hospitalization in COVID-19 patients, Respir Med,
doi:10.1016/j.rmed.2021.106313
Nardone, Casey, Morello-Frosch, Mujahid, Balmes et al., Associations between historical residential redlining and current age-adjusted rates of emergency department visits due to asthma across eight cities in California: an ecological study, Lancet Planet Heal,
doi:10.1016/S2542-5196%2819%2930241-4
Nardone, Rudolph, Morello-Frosch, Casey, Redlines and greenspace: The Relationship between historical redlining and 2010 greenspace across the United States, Environ Health Perspect,
doi:10.1289/EHP7495
Okoh, Sossou, Dangayach, Meledathu, Phillips et al., Coronavirus disease 19 in minority populations of Newark, New Jersey, Int J Equity Health,
doi:10.1186/s12939-020-01208-1
Olusola, Olusola, Onafeso, Ajiola, Adelabu, Early geography of the coronavirus disease outbreak in Nigeria, GeoJournal,
doi:10.1007/s10708-020-10278-1
Palm, Allen, Liu, Zhang, Widener et al., Riders who avoided public transit during COVID-19: Personal burdens and implications for social equity, J Am Plan Assoc,
doi:10.1080/01944363.2021.1886974
Pandey, Elliott, Suppressor variables in social work research: Ways to identify in multiple regression models, J Soc Social Work Res,
doi:10.5243/jsswr.2010.2
Paul, Arif, Pokhrel, Ghosh, The association of social determinants of health with COVID-19 mortality in rural and urban counties, J Rural Heal,
doi:10.1111/jrh.12557
Pinheiro, Luı, Nc, COVID-19 could leverage a sustainable built environment, Sustainability,
doi:10.3390/su12145863
Polack, Thomas, Kitchin, Absalon, Gurtman et al., Safety and efficacy of the BNT162b2 mRNA Covid-19 vaccine, N Engl J Med,
doi:10.1056/NEJMoa2034577
Ramı ´rez, Lee, COVID-19 emergence and social and health determinants in Colorado: A rapid spatial analysis, Int J Environ Res Public Health,
doi:10.3390/ijerph17113856
Reid, Rieves, Carlson, Perceptions of green space usage, abundance, and quality of green space were associated with better mental health during the COVID-19 pandemic among residents of Denver, PLoS One,
doi:10.1371/journal.pone.0263779
Rundle, Bader, Mooney, The disclosure of personally identifiable information in studies of neighborhood contexts and patient outcomes, J Med Internet Res,
doi:10.2196/30619
Sallis, Young, Tartof, Sallis, Sall et al., Physical inactivity is associated with a higher risk for severe COVID-19 outcomes: a study in 48 440 adult patients, Br J Sports Med,
doi:10.1136/bjsports-2021-104080
Spotswood, Benjamin, Stoneburner, Wheeler, Beller et al., Nature inequity and higher COVID-19 case rates in less-green neighbourhoods in the United States, Nat Sustain,
doi:10.1038/s41893-021-00781-9
Sun, Zhang, Yang, Wan, Wang, Impacts of geographic factors and population density on the COVID-19 spreading under the lockdown policies of China, Sci Total Environ,
doi:10.1016/j.scitotenv.2020.141347
Tan S Bin, Desouza, Raifman, Structural racism and COVID-19 in the USA: A county-level empirical analysis, J Racial Ethn Heal Disparities,
doi:10.1007/s40615-020-00948-8
Tan S Bin, Desouza, Raifman, Structural racism and COVID-19 in the USA: A county-level empirical analysis. J Racial Ethn Heal Disparities,
doi:10.1007/s40615-020-00948-8
Telenti, Arvin, Corey, Corti, Diamond et al., After the pandemic: perspectives on the future trajectory of COVID-19, Nature,
doi:10.1038/s41586-021-03792-w
Tessum, Paolella, Chambliss, Apte, Hill et al., PM2.5 polluters disproportionately and systemically affect people of color in the United States, Sci Adv,
doi:10.1126/sciadv.abf4491
Tipirneni, Karmakar, Malley, Prescott, Chopra, Contribution of individual-and neighborhood-level social, demographic, and health factors to COVID-19 hospitalization outcomes, Ann Intern Med,
doi:10.7326/M21-2615
Walkscore, Walkability, real estate, and public health data
Wang, Wu, Wang, He, Li et al., Review of associations between built environment characteristics and severe acute respiratory syndrome coronavirus 2 infection risk, Int J Environ Res Public Health,
doi:10.3390/ijerph18147561
Willan, King, Jeffery, Bienz, Challenges for NHS hospitals during COVID-19 epidemic, BMJ,
doi:10.1136/bmj.m1117
Xiao, The road to racial justice: Resolving the disproportionate health burden placed on communities of color by highway pollution. Columbia Human Rights Law Rev
You, Pan, Urban vegetation slows down the spread of coronavirus disease (COVID-19) in the United States, Geophys Res Lett,
doi:10.1029/2020GL089286
Zhang, Schwartz, Spatial disparities in coronavirus incidence and mortality in the United States: An ecological analysis as of, J Rural Heal,
doi:10.1111/jrh.12476
Zhao, Fang, Feng, Fang, He et al., Emerging role of air pollution and meteorological parameters in COVID-19, J Evid Based Med,
doi:10.1111/jebm.12430
Zhu, Maharajan, Liu, Zhang, Role of atmospheric particulate matter exposure in COVID-19 and other health risks in human: A review, Environ Res,
doi:10.1016/j.envres.2021.111281