Environmental Factors Predicting Risk of Severe COVID Infection

Project Summary/ Abstract The objective of this project is to identify the effect of air pollution on the risk and severity of COVID-19 illness. Air pollution may increase the risk of viral infections of the lung in general and there is emerging evidence that COVID-19 illness may be increased in regions where air pollution levels are high. Identification of factors that increase risk of COVID-19 illness will have major public health impacts. We will assess the incidence, prevalence and severity of COVID-19 infection within COPDGene, a well-characterized, longitudinal cohort of subjects with and without existing lung disease. The cohort is distributed at 20 clinical centers across the United States and includes subjects with a broad distribution of socioeconomic characteristics, rural and urban locations and air pollution exposures. The cohort was enriched for African-American subjects. We will adjust for other socioeconomic factors in the models using county level census data and normalize the cohort data to county level disease prevalence. Longitudinal analyses of COVID-19 incidence in relation to changing levels of monthly air pollution will be done and the impact of pre-existing lung disease on the outcomes will be studied. The air pollution data will be based on spatial analysis of the cohort using satellite and ground monitoring measures of particulates, NOx, SO2, CO and ozone, to identify factors that modify risk of: any disease, severe disease or death. The impact of air pollution on lung structural damage after COVID-19 illness will be measured using pre and post-COVID chest CT scans and spirometric changes in the cohort to identify extent of lung involvement and persistent effects.