Environmental equity and COVID-19 experiences among a nationally representative cohort

Abstract

BACKGROUND AND AIM: We assessed associations of (1) individual environmental exposures and (2) an environmental inequity construct with diverse COVID-19 experiences. We also assessed whether discrimination experience and race/ethnicity (a proxy for structural racism) modified these relationships. METHODS: We conducted a nationally representative survey (n=1267) to collect individual-level COVID-19 experience data: personal/family history, health care access/sick leave, assistance from government/non-profit sources, volunteering/caretaking, and vaccination willingness (all dichotomized). We linked individual data to environmental exposure data: annual average particulate matter (PM2.5; continuous), county-level greenspace (dichotomous), county-level toxic release inventory (TRI) sites (dichotomous), county-level heat wave days, and individual-reported climate stress. We assessed associations between each environmental exposure and COVID-19 experience using logistic regression models adjusted for individual and population-level sociodemographic factors. We assessed effect measure modification by discrimination experience and race/ethnicity. We used structural equation models to assess whether environmental inequity (latent construct) was associated with each COVID-19 experience. The latent environmental inequity construct was defined using environmental exposures as indicators. We included a covariance term between the environmental inequity construct and a demographic context latent variable. RESULTS:The environmental inequity construct was not associated with COVID-19 experiences, but individual environmental exposures associated with COVID-19 experiences included: climate stress with health care access (adjusted odds ratio (aOR)=0.75; 95% confidence interval (CI)=0.57,0.99) and vaccination willingness (aOR=2.86; 95%CI=2.13,3.84); TRI sites and vaccination willingness (aOR=1.35; 95%CI=0.96,1.89); and PM2.5 with volunteering/caretaking (aOR=1.16; 95%CI=1.02,1.32). Associations modified by race/ethnicity or discrimination experience included: climate stress with health care access, receiving assistance, and willingness to vaccinate; TRI with vaccination willingness; greenspace with health care access and receiving assistance; heat wave days with vaccination willingness; and PM2.5 with personal/family health outcomes and receiving assistance. CONCLUSIONS:Although a combined environmental inequity construct was not associated with COVID-19 experiences, individual environmental exposures were associated with COVID-19 experiences and associations were modified by discrimination and racism experiences. KEYWORDS: Environmental disparities, environmental justice, COVID-19, multi-pollutant/multi-media