Dissertations & Theses (Open Access)

Date of Award

12-2022

Degree Name

Doctor of Philosophy (PhD)

Advisor(s)

William Perkison

Second Advisor

Eric Brown

Third Advisor

Cici Bauer, George Delclos, Abiodun Oluyomi, Grace Lewis

Abstract

The COVID-19 pandemic exposed long-standing inequities that have been present in the United States since its origin. While the entire country has been devastated by this pandemic, low-income and minority communities were hardest hit. Race alone does not predict poor health outcomes. Rather, the historic strategies implemented in the United States, such as redlining, placed racial and ethnic minorities in neighborhoods where cycles of disinvestment in education, transportation infrastructure, flooding infrastructure, healthy food, and clean air and water have created low socioeconomic status and poor health outcomes. This public health research aims to understand how historical processes have created and maintained social, economic, and environmental conditions that give rise to poor health during pandemics. We investigated whether exposure to air pollution, pre-existing chronic disease, and various factors that determine socioeconomic status are contributing to increased mortality following COVID-19. A multivariable logistic regression analysis was done on a population of COVID-19 cases that had been reported to Harris County Public Health between March 2020 and March 2022. In this study, we found that the odds of COVID-19 mortality were 37% higher in Hispanic and 20% higher in Black individuals compared to non-Hispanic White individuals after adjusting for age, race, gender, and PM2.5 exposure. After adjusting for age, race, gender, pre-existing chronic disease, and social vulnerability, a 1µg/m3 increase in the 14-day average PM2.5 exposure increases the odds of mortality by 6%. Additionally, the odds of COVID-19 mortality in those reporting obesity were 11.09 times the odds of mortality in those who did not report obesity and obesity had the highest risk of all reported pre-existing chronic conditions. Finally, after adjusting for, age, race, gender, pre-existing chronic disease, and PM2.5 exposure, the odds of COVID-19 mortality are 77% higher in those living in census tracts with the highest SVI score (0.75 – 1) compared to those living in census tracts with the lowest SVI score (0 - 0.25). The findings evidenced in this research indicate that modifiable factors such as air pollution exposure, pre-existing chronic disease, and social vulnerability may be contributing to an increased risk of mortality following COVID-19 illness. Thus, offices and divisions within local health departments that are responsible for targeting public health interventions such as chronic disease prevention and pollution control services may consider making an effort to continue these essential services and, in some cases, even strengthen these services during public health emergencies like the COVID-19 pandemic. Additionally, local health departments may consider incorporating the lessons identified in this research in their Infectious Disease Response Plan, Continuity of Operations Plan, and standard operating guides pertaining to vulnerable populations during public health emergencies.

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