key: cord-0889273-dssb06bc
authors: Dey, Tanujit; Dominici, Francesca
title: COVID-19, Air Pollution, and Racial Inequity: Connecting the Dots
date: 2020-12-30
journal: Chem Res Toxicol
DOI: 10.1021/acs.chemrestox.0c00432
sha: c8506f514e6886cc76fb89ada884f6e3ec0f5b6a
doc_id: 889273
cord_uid: dssb06bc

[Image: see text] COVID-19 pandemic is a public health emergency. Exposure to air pollution represents a serious health issue in overall mortality worldwide. The health risks of some racial subgroups are spiraling as they have higher levels of exposure to air pollutants, hence being more susceptible to mortality from COVID-19.

effects of PM 2.5 on mortality among 60 million United States' Medicare enrollees. 4 Recognizing the limitations of an ecological study design, we found that an increase of 1 μg/ m 3 in long-term PM 2.5 exposure is associated with an 8%−11% increase in COVID-19 mortality rate. Our findings align with numerous studies in China and Italy that report similar findings. This is a rapidly evolving research area, and we anticipate that more studies will appear in peer-reviewed literature in the near future.

In addition to the growing evidence that air pollution might increase vulnerability to COVID-19 resulting in hospitalization and/or death, there is another serious aspect revealed as the pandemic progresses−racial disparity. The APM Research Lab (apmresearchlab.org) reported that there are wide disparities by race; the COVID-19 mortality rates are higher among African Americans and Indigenous Americans compared to White Americans. However, when age-adjusted, the mortality rates for Latinos was much higher than any other groups. In our nationwide study, 5 we reported that counties that have with a higher proportion of African Americans residents are at higher risk of COVID-19 mortality. We also found a 45% increase in COVID-19 mortality rate (CI: 32%, 60%) associated with a 1 standard deviation (per 14.2%) increase in percent African American residents. Underprivileged neighborhoods of Detroit, Chicago, and St. James Parish in Louisiana have experienced some of the country's highest mortality rates from the virus. For example, in Louisiana, 70.5% of deaths have occurred among African Americans, although they only represent 32.2% of the state's population. 6 The death rate from COVID-19 is six times higher in African American counties than in White American counties. 6 Even though these are prefatory data and further studies are needed, the pattern of being infected by the virus and the resulting mortality are undeniable. A recent study by Sutter Health (https://www.sutterhealth.org) shows that after adjusting for comorbidities, minorities are still more vulnerable to the adverse outcomes of COVID-19. This pandemic spotlighted racial disparities and the urgent need to address the causes underlying these inequities. First, racial/ethnic minority populations have a disproportionate burden of underlying comorbidities related to diabetes, cardiovascular disease, asthma, human immunodeficiency virus, morbid obesity, liver disease, and kidney disease. Second, racial/ethnic minorities in urban areas live in more crowded conditions and are more likely to be employed in public-facing roles (e.g., services, transportation, and construction), which limits physical distancing.

When social determinants operate along with health disparities, there is an increase in chronic diseases. Minorities are at a higher risk as a result of limited access to health care, lack of insurance, or minimal access to healthcare providers for routine health assessment, and limited access to green space. Healthcare establishments need to work together to identify and extend their role in addressing the underlying causes that contribute this disparity. They should re-evaluate their outlook, actions, administration, and legislation to address the conditions that contribute to health disparities in these populations. 7 The COVID-19 pandemic will end, but without action, the inequities will remain. We need to thoroughly evaluate environmental racism−systems that produce and perpetuate inequalities in exposure to environmental pollutants and their long-term health effects. 

Virology, transmission, and pathogenesis of SARS-CoV-2

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Air Pollution and Mortality in the Medicare Population

Air pollution and COVID-19 mortality in the United States: strengths and limitations of an ecological regression analysis

COVID-19 and African Americans

COVID's Color Line − Infectious Disease, Inequality, and Racial Justice