Identifying environmental risk factors for post-acute sequelae of SARS-CoV-2 infection: An EHR-based cohort study from the recover program - PubMed (original) (raw)

doi: 10.1016/j.envadv.2023.100352. Epub 2023 Feb 8.

Hui Hu 2, Vasilios Fokaidis 1, Colby Lewis V 1, Jie Xu 3, Chengxi Zang 1, Zhenxing Xu 1, Fei Wang 1, Michael Koropsak 1, Jiang Bian 3, Jaclyn Hall 3, Russell L Rothman 4, Elizabeth A Shenkman 3, Wei-Qi Wei 5, Mark G Weiner 1, Thomas W Carton 6, Rainu Kaushal 1

Affiliations

Identifying environmental risk factors for post-acute sequelae of SARS-CoV-2 infection: An EHR-based cohort study from the recover program

Yongkang Zhang et al. Environ Adv. 2023 Apr.

Abstract

Post-acute sequelae of SARS-CoV-2 infection (PASC) affects a wide range of organ systems among a large proportion of patients with SARS-CoV-2 infection. Although studies have identified a broad set of patient-level risk factors for PASC, little is known about the association between "exposome"-the totality of environmental exposures and the risk of PASC. Using electronic health data of patients with COVID-19 from two large clinical research networks in New York City and Florida, we identified environmental risk factors for 23 PASC symptoms and conditions from nearly 200 exposome factors. The three domains of exposome include natural environment, built environment, and social environment. We conducted a two-phase environment-wide association study. In Phase 1, we ran a mixed effects logistic regression with 5-digit ZIP Code tabulation area (ZCTA5) random intercepts for each PASC outcome and each exposome factor, adjusting for a comprehensive set of patient-level confounders. In Phase 2, we ran a mixed effects logistic regression for each PASC outcome including all significant (false positive discovery adjusted p-value < 0.05) exposome characteristics identified from Phase I and adjusting for confounders. We identified air toxicants (e.g., methyl methacrylate), particulate matter (PM2.5) compositions (e.g., ammonium), neighborhood deprivation, and built environment (e.g., food access) that were associated with increased risk of PASC conditions related to nervous, blood, circulatory, endocrine, and other organ systems. Specific environmental risk factors for each PASC condition and symptom were different across the New York City area and Florida. Future research is warranted to extend the analyses to other regions and examine more granular exposome characteristics to inform public health efforts to help patients recover from SARS-CoV-2 infection.

Keywords: Air pollution; Built environment; Exposome; Long-COVID; Neighborhood deprivation; SARS-CoV-2 infection.

© 2023 The Author(s).

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Conflict of interest statement

We declare that we have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Image, graphical abstract

Graphical abstract

Fig 1

Fig. 1

Significant Exposome Factors Associated with PASC Groups in Phase 1 Analysis Using INSIGHT Sample.

Fig 2

Fig. 2

Significant Exposome Factors Associated with PASC Groups in Phase 1 Analysis Using OneFlorida+ Sample.

Fig 3

Fig. 3

Environmental Risk Factors for PASC Conditions by Organ System.

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