Abstract
COVID-19, the disease caused by SARS-CoV-2, has caused a pandemic, sparing few regions. However, limited reports suggest differing infection and death rates across geographic areas including populations that reside at higher elevations (HE). We aimed to determine if COVID-19 infection, death, and case mortality rates differed in higher versus low elevation (LE) U.S. counties. Using publicly available geographic and COVID-19 data, we calculated per capita infection and death rates and case mortality in population density matched HE and LE U.S. counties. We also performed population-scale regression analysis to investigate the association between county elevation and COVID-19 infection rates. Population density matching of LA (< 914m, n = 58) and HE (>2133m, n = 58) counties yielded significantly lower COVID-19 cases at HE versus LE (615 versus 905, p = 0.034). HE per capita deaths were significantly lower than LE (9.4 versus 19.5, p = 0.017). However, case mortality did not differ between HE and LE (1.78% versus 1.46%, p = 0.27). Regression analysis, adjusted for relevant covariates, demonstrated decreased COVID-19 infection rates by 12.82%, 12.01%, and 11.72% per 495m of county centroid elevation, for cases recorded over the previous 30, 90, and 120 days, respectively. This population-adjusted, controlled analysis suggests that higher elevation attenuates infection and death. Ongoing work from our group aims to identify the environmental, biological, and social factors of residence at HE that impact infection, transmission, and pathogenesis of COVID-19 in an effort to harness these mechanisms for future public health and/or treatment interventions.
Highlights
Coronavirus disease 2019 (COVID-19) is an illness caused by novel coronavirus Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) that emerged in Wuhan, China in late 2019 and has rapidly proceeded to cause a pandemic
Regression analysis, adjusted for relevant covariates, demonstrated decreased COVID-19 infection rates by 12.82%, 12.01%, and 11.72% per 495m of county centroid elevation, for cases recorded over the previous 30, 90, and 120 days, respectively. This population-adjusted, controlled analysis suggests that higher elevation attenuates infection and death
In an effort to reflect the temporal dynamics of the pandemic, we evaluated the association of county centroid elevation with incidence recorded over the previous 30, 90, and 120 days
Summary
Coronavirus disease 2019 (COVID-19) is an illness caused by novel coronavirus Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) that emerged in Wuhan, China in late 2019 and has rapidly proceeded to cause a pandemic. While individual risk factors such as age, male sex, hypertension, diabetes, and heart disease have been previously identified [1], COVID-19 appears to have unequal infection rates and mortality across geographical regions, suggesting that a combination of social, environmental, and biological risk factors may affect transmission, infection, morbidity, and mortality One such environmental factor which has attracted interest over the past few months and which our group has significant interest and expertise, is high altitude residence. In an effort to reflect the temporal dynamics of the pandemic, we evaluated the association of county centroid elevation with incidence recorded over the previous 30, 90, and 120 days To our knowledge, this is the first systematic, population-density adjusted epidemiologic investigation of the impact of altitude on COVID19 disease infection, deaths, and mortality rates in the U.S Further, we discuss the biological, social, and environmental contributors to COVID-19 infection, transmission, and pathogenesis, and how these factors are impacted by residence at high altitude. We aimed to determine if COVID-19 infection, death, and case mortality rates differed in higher versus low elevation (LE) U.S counties
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