% E E # #HE SCIENCE
Second, data reported to the Indiana Department of Health are often incomplete, leading to low-quality race and ethnicity data. Despite data cleaning eorts to enhance the quality of case investigation demographic data, 10.9% of cases and 19.5% of controls in our analysis had an unknown race, and 23.8% of cases and 30.6% of controls had an unknown ethnicity. Third, our study was able to assess out- door air pollution exposure only, as indoor air pollution levels were unable to be obtained. Indoor air pollution exposure is expected to vary widely and would greatly aect the actual dose of the measured pol- lutants for the study population (Serafini et al., 2022). Fourth, the data were found to have expo- sure variables with low variability. Within
the study dataset, average O 3 had a range of 0.03 ppm and average CO had a range of 0.28 ppm. These variables had low variability for the sampled counties; as such, these vari- ables were determined to be poor predictors of mortality from COVID-19 and thus were excluded from the models. Conclusion This study identified an increased risk of death from COVID-19 in relation to each 1 μg/m 3 increase in PM 2.5 at the popula- tion level, and in relation to each 1 μg/m 3 increase in PM 10 in individuals with a previ- ously diagnosed chronic lung disease. Addi- tionally, our study found a protective asso- ciation for COVID-19 mortality per every 1 ppb of NO 2 . More research is required to further investigate these associations and to
support policy change eorts to strengthen air pollution regulation.
Acknowledgments: The authors acknowl- edge Thomas Duszynski, MPH, PhD, CPH; Jianjun Zhang, MD, PhD; Hailey Vest, MPH; Darren Frank, MPH; Jennifer Brown, MPH, DVM, DACVPM; Kelly White, MPH, CPH; Ronald Clark; the members of the Indiana Department of Health CDC Reporting Team; and everyone who participated in the 2020 Indiana Department of Health COVID-19 response. Your tireless work and support have made this eort possible.
Corresponding Author: Anna E. Heilers, Indi- ana Department of Health, 2 North Meridian
Street, Indianapolis, IN 46204. Email: aeheilers@gmail.com
References
Alqahtani, J.S., Aldhahir, A.M., Al Ghamdi, S.S., AlBahrani, S., AlD- raiwiesh, I.A., Alqarni, A.A., Latief, K., Raya, R.P., & Oyelade, T. (2022). Inhaled nitric oxide for clinical management of COVID- 19: A systematic review and meta-analysis. International Journal of Environmental Research and Public Health , 19 (19), Article 12803. https://doi.org/10.3390/ijerph191912803 Centers for Disease Control and Prevention. (2024). National Center for Health Statistics: Indiana . https://www.cdc.gov/nchs/pressroom/ states/indiana/in.htm Copat, C., Cristaldi, A., Fiore, M., Grasso, A.D., Zuccarello, P., Signorelli, S.S., Conti, G.O., & Ferrante, M. (2020). The role of air pollution (PM and NO 2 ) in COVID-19 spread and lethality: A systematic review. Environmental Research , 191 , Article 110129. https://doi.org/10.1016/j.envres.2020.110129 Hagenbjörk, A., Malmqvist, E., Mattisson, K., Sommar, N.J., & Modig, L. (2017). The spatial variation of O 3 , NO, NO 2 and NO x and the relation between them in two Swedish cities. Environmen- tal Monitoring and Assessment , 189 (4), Article 161. https://doi. org/10.1007/s10661-017-5872-z Karan, A., Ali, K., Teelucksingh, S., & Sakhamuri, S. (2020). The impact of air pollution on the incidence and mortality of COVID- 19. Global Health Research and Policy , 5 (1), Article 39. https://doi. org/10.1186/s41256-020-00167-y Kimbrough, S., Owen, R.C., Snyder, M., & Richmond-Bryant, J. (2017). NO to NO 2 conversion rate analysis and implications for dispersion model chemistry methods using Las Vegas, Nevada, near-road field measurements. Atmospheric Environment , 165 , 23–34. https://doi.org/10.1016/j.atmosenv.2017.06.027 Marian, B., Yan, Y., Chen, Z., Lurmann, F., Li, K., Gilliland, F., Eckel, S.P., & Garcia, E. (2022). Independent associations of short- and long-term air pollution exposure with COVID-19 mortality
among Californians. Environmental Advances , 9 , Article 100280. https://doi.org/10.1016/j.envadv.2022.100280 Meo, S.A., Abukhalaf, A.A., Alessa, O.M., Alarifi, A.S., Sami, W., & Klono, D.C. (2021). Eect of environmental pollutants PM 2.5 , CO, NO 2 , and O 3 on the incidence and mortality of SARS-CoV-2 infection in five regions of the USA. International Journal of Envi- ronmental Research and Public Health , 18 (15), Article 7810. https:// doi.org/10.3390/ijerph18157810 Rajendran, R., Chathambath, A., Al-Sehemi, A.G., Pannipara, M., Unnikrishnan, M.K., Aleya, L., Raghavan, R.P., & Mathew, B. (2022). Critical role of nitric oxide in impeding COVID-19 trans- mission and prevention: A promising possibility. Environmental Science and Pollution Research , 29 (26), 38657–38672. https://doi. org/10.1007/s11356-022-19148-4 Serafini, M.M., Maddalon, A., Iulini, M., & Galbiati, V. (2022). Air pollution: Possible interaction between the immune and ner- vous system? International Journal of Environmental Research and Public Health , 19 (23), Article 16037. https://doi.org/10.3390/ ijerph192316037 Weaver, A.K., Head, J.R., Gould, C.F., Carlton, E.J., & Remais, J.V. (2022). Environmental factors influencing COVID-19 incidence and severity. Annual Review of Public Health , 43 (1), 271–291. https://doi.org/10.1146/annurev-publhealth-052120-101420 Xu, L., Taylor, J.E., & Kaiser, J. (2022). Short-term air pollution expo- sure and COVID-19 infection in the United States. Environmental Pollution , 292 (Pt. B), Article 118369. https://doi.org/10.1016/j. envpol.2021.118369 Zang, S.-T., Luan, J., Li, L., Yu, H.-X., Wu, Q.-J., Chang, Q., & Zhao, Y.-H. (2022). Ambient air pollution and COVID-19 risk: Evidence from 35 observational studies. Environmental Research , 204 (Pt. B), Article 112065. https://doi.org/10.1016/j.envres.2021.112065
12
%olume • um(er
Powered by FlippingBook