Long-Term Fine Particulate Matter Concentrations and Prevalence of Severe Acute Respiratory Syndrome Coronavirus 2: Differential Relationships by Socioeconomic Status Among Pregnant Individuals in New York City.

Abstract

We aimed to determine if long-term fine particulate matter (PM2.5) concentrations are associated with increased risk of testing positive for COVID-19 among pregnant individuals who were universally screened at delivery and if socioeconomic status (SES) modifies this relationship. We used obstetric data from Columbia University Irving Medical Center in New York City from March–December 2020, which included Medicaid use (low-SES surrogate) and coronavirus disease 2019 (COVID-19) test results. We linked 300m resolution estimated 2018-2019 PM2.5 concentrations and census tract-level population density, household size and income, and mobility estimates. Analyses included 3318 individuals; 5% tested positive for COVID-19 at delivery, 8% tested positive during pregnancy, 48% used Medicaid, and average long-term PM2.5 concentrations were 7.4 μg/m3 (SD = 0.8). In adjusted multilevel logistic regression models, we saw no association between PM2.5 and ever-testing positive for COVID-19; however, odds were elevated among those using Medicaid (odds ratio = 1.6, 95% CI 1.0, 2.5 per 1-μg/m3 increase). Further, while only 22% of those testing positive showed symptoms, 69% of symptomatic individuals used Medicaid. SES, including unmeasured occupational exposures or increased susceptibility to the virus due to co-social and environmental exposures, may explain the increased odds of testing positive for COVID-19 confined to vulnerable pregnant individuals using Medicaid.