The range of COVID-19 symptoms varies-; some feel a gentle cold, others are hospitalized, while others perish. Many studies have linked the severity of COVID-19 symptoms with a person’s biological aspects, but less is understood concerning the impact of non-biological aspects, equivalent to the environment wherein people live.

A latest study that published on June 14, 2023, within the journal PLoS ONE, is the primary to indicate that the neighborhood-built environment might pose an independent risk determining the individuals hospitalized resulting from COVID-19 illness.

The authors found that in a cohort of greater than 18,000 individuals with SARS-CoV-2 infections, living in multi-family constructing, living in a neighborhood with higher air pollution (PM2.5) levels and living in a neighborhood with lower walkability and bike-ability were related to a greater incidence rate of hospitalization, even when controlling for socioeconomic vulnerability and individual-level demographic and medical characteristics. Neighborhoods with higher public transit quality and access were also related to a better incidence rate of hospitalization.

The study identified differences between the 2 largest ethnic groups within the region. Higher PM2.5 levels posed a better rate of hospitalization for Latinx individuals, and density and overcrowding showed stronger associations for non-Hispanic White individuals.

The findings could help inform public health and concrete planning initiatives in lowering the danger of hospitalizations linked to COVID-19 and other respiratory pathogens.

“For urban planners, the findings underline what we’re already attempting to do to construct healthier communities-;create more walkability, bike-ability and infrastructure that can reduce air pollution,” said Alessandro Rigolon, associate professor on the University of Utah and lead writer of the study. “From a public health perspective, the findings might help testing and vaccination campaigns goal areas with higher air pollution or multi-family housing.”

The study also exposed how urban policies from the past proceed impact the each day lives of many communities.

“We found much higher rates of COVID-19 hospitalizations along the I-25 and I-70 corridors and in the commercial areas of North Denver,” said Jeremy Németh, professor on the University of Colorado Denver and co-author of the study. “These are the identical areas which have experienced a long time of disinvestment and increased air pollution resulting from racist land-use policies levied on our cities within the early twentieth century.”

Neighborhood-built environments

The study analyzed the neighborhood characteristics within the Denver Metro Area related to hospitalizations of 18,042 individuals who tested positive for SARS-CoV-2 between May and December in 2020, before vaccines became extensively available. Researchers from two of the Denver Metro Area’s major health care systems, Denver Health and University of Colorado Hospital, reviewed greater than 30,000 cases of eligible individuals. They limited the cohort to those living within the greater metro area, and matched available health record data for every case. Variables pulled from the medical record included age and body mass index (BMI), evidence of tobacco use, hypertension, chronic lung disease, some types of heart problems and chronic kidney disease. Researchers on the University of Colorado Denver then converted addresses of individuals in the ultimate cohort to their geospatial coordinates and assigned environmental variables accordingly.

Ethical oversight and approval for the study was granted by the Colorado Multiple Institutional Review Board and all protected health information was anonymized prior to sharing.

“Only a few studies are comprehensive like ours. We’re in a position to control for some individual level aspects that, for individuals with COVID-19, would result in higher possibilities of being hospitalized,” said Rigolon.

With biological aspects largely accounted for, the authors identified 4 characteristics of a neighborhood which may contribute to COVID-19 hospitalization: density and overcrowding, including living in an overcrowded home or multi-family constructing; environmental hazards, equivalent to air pollution levels (PM 2.5) and proximity to highways; environmental amenities, including access to parks; and mobility options, including public transit access, walkability and bike-ability.

The authors were unsurprised that individuals with compromised lung and immune systems who face chronic air pollution can be unable to reply as well to the respiratory disease and can be more prone to need hospitalization after contracting COVID-19. Their finding that higher PM2.5 levels impacted Latinx individuals greater than non-Hispanic White individuals underscores a worldwide problem-;air pollution disproportionately affects People of Color. While findings support making existing neighborhoods more walkable and bikeable, the authors emphasized that future planning efforts to cut back emissions should center the principles of environmental justice. Since walkability was particularly protective in Latinx communities, the authors suggest that cities should prioritize investing to make Latinx-dominant neighborhoods pedestrian-friendly.

The result for density and overcrowding underscore the necessity for vaccination and testing efforts to concentrate on areas with multi-family housing to mitigate risk of severe disease. Because living in transit-rich neighborhoods was related to higher risk of hospitalization from COVID-19, public health measures like educational campaigns and outreach in these areas are particularly necessary.

“So many health disparities track along geographic lines. We have long suspected that greater than just pre-existing medical conditions were in charge for the disparities. It was interesting to work with the urban planning teams to pinpoint exactly which environmental aspects were partially in charge for disproportionate rates of hospitalizations that we keep seeing. It will help public health leaders proceed to advocate for healthier cities, and it helps inform outreach efforts to deal with COVID-19 and other respiratory illnesses,” said Sarah Rowan, associate professor of drugs at University of Colorado School of Medicine, Denver Health infectious diseases physician and the study’s senior writer.

Neighborhoods in other areas, other diseases?

The authors would love to duplicate this study in other regions equivalent to within the Salt Lake Valley in Utah, which has similar environmental and population characteristics because the Denver Metro Area. They’d also prefer to expand to other respiratory diseases where persons are hospitalized, equivalent to the flu. Though it took multiple years to process the large quantity of patient records, studies that may have a look at health outcomes and the built environment on a person level are useful.

“Urban planning was born out of public health concerns within the U.S. when cities were getting very crowded, very polluted and sanitation was a problem. It’s only natural that urban planners do research that involves public health,” said Rigolon.

Additional contributing authors include Brenn Anderson-Gregson, Ann Rae Miller and Priyanka deSouza of the Department of Urban and Regional Planning, University of Colorado Denver; Brian Montague and Kristine M. Erlandson of the Division of Infectious Diseases, University of Colorado School of Medicine; and Cory Hussain, University of Colorado School of Medicine and Denver Health.

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Journal reference:

DOI: 10.1371/journal.pone.0286119