Neighborhood environmental vulnerability factors strongly drove COVID-19 fatality and excess all-cause mortality in New York City, while long-term air pollutant associations were weak and varied.

PURPOSE: We evaluated associations among long-term air pollution exposure, neighborhood-level social and structural drivers of environmental vulnerability, and COVID-19 death during the first pandemic year in New York City (NYC).

METHODS

We triangulated findings across statistical approaches susceptible to different biases: a hospital-based COVID-19 fatality analysis using Cox proportional hazard models and two ZIP code-level, city-wide excess all-cause mortality analyses using periodic and linear regression models. We estimated chronic fine particulate matter (PM2.5), nitrogen dioxide (NO2), and ozone (O3) exposures as 11-year mean concentrations. Social and structural factors were integrated into a neighborhood environmental vulnerability index (NEVI), with higher scores indicating greater vulnerability.

RESULTS

Cox models demonstrated PM2.5 (0.88 [0.84, 0.93]) and NO2 (0.84 [0.79, 0.89]) exposures were weakly and negatively associated, while O3 (1.06 [1.04, 1.08]) exposure was weakly and positively associated with COVID-19 fatality. Linear regression models showed similar PM2.5 (-0.64 [-0.87, -0.41]), NO2 (-0.53 [-0.71, -0.34]), and O3 (0.55 [0.39, 0.71]) associations with excess all-cause mortality. NEVI scores were strongly and positively associated with COVID-19 fatality and excess all-cause mortality across air pollutant concentrations. Periodic regression models showed the highest monthly excess all-cause mortality rates per 10,000 were observed in ZIP codes with low PM2.5 (40.54) and NO2 (33.99) with high NEVI scores and high O3 (32.39) with high NEVI scores.

CONCLUSIONS

Inverse PM2.5, NO2, and COVID-19 death associations were unexpected, highlighting challenges in examining these associations in NYC. Future pandemic preparedness efforts should prioritize urban communities burdened by structurally rooted health vulnerabilities, even in areas with low air pollution exposure.