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. 2025 Aug 10:989:179874.
doi: 10.1016/j.scitotenv.2025.179874. Epub 2025 Jun 14.

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

Alexander Azan  1 , Sneha Kannoth  2 , Cong Zhang  2 , Mehr Shafiq  2 , Earle C Chambers  3 , Perry E Sheffield  4 , Sandra S Albrecht  2 , Azure Thompson  5 , Jennifer Woo Baidal  6 , Min Qian  2 , Stephanie Lovinsky-Desir  6 , Jeanette A Stingone  2
Affiliations

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

Alexander Azan et al. Sci Total Environ. .

Abstract

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.

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Conflict of interest statement

Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Alexander Azan reports financial support was provided by National Center for Advancing Translational Sciences. Alexander Azan reports financial support was provided by Health Resources and Services Administration. Jeanette A. Stingone reports financial support was provided by Health Effects Institute. Jeanette A. Stingone reports financial support was provided by National Institute of Environmental Health Sciences. Stephanie Lovinsky-Desir reports financial support was provided by National Institute of Environmental Health Sciences. Perry E. Sheffield reports financial support was provided by National Institute of Environmental Health Sciences. Stephanie Lovinsky-Desir reports financial support was provided by National Heart Lung and Blood Institute. Earle C. Chambers reports financial support was provided by National Heart Lung and Blood Institute. Earle C. Chambers reports financial support was provided by National Institute of Diabetes, Digestive and Kidney Disorders. Sandra S. Albrecht reports financial support was provided by National Institute of Diabetes, Digestive and Kidney Disorders. Sneha Kannoth reports financial support was provided by National Institute of Allergy and Infectious Diseases. Stephanie Lovinsky-Desir reports financial support was provided by Robert Wood Johnson Foundation. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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