Abstract
Recent research suggests greater COVID-19 prevalence in areas burdened with higher exposure to chronic air pollution, but previous studies have not examined if socially disadvantaged populations are more likely to reside in communities located at the convergence of both COVID-19 and air pollution health risks. This article presents a national scale U.S. study that investigates whether racial/ethnic minorities, socioeconomically deprived residents, and other vulnerable groups are significantly overrepresented in counties where significantly higher COVID-19 incidence spatially coincides with higher respiratory health risks from outdoor exposure to hazardous air pollutants (HAPs). COVID-19 data from the Johns Hopkins Center for Systems Science and Engineering database are linked to respiratory risk estimates from the U.S. Environmental Protection Agency's National Air Toxics Assessment and variables from the 2018 American Community Survey. Bivariate local measures of spatial association are implemented to identify county clusters representing relationships between COVID-19 incidence rate and respiratory risk from HAP exposure. Socio-demographic characteristics of these clusters are compared using bivariate statistical tests and multivariable generalized estimating equations. Counties where greater COVID-19 incidence coincides significantly with higher HAP respiratory risk contain disproportionately higher percentages of non-Hispanic Black, socioeconomically deprived, and uninsured residents than all other U.S. counties, after controlling for spatial clustering, population density, older age, and other contextual factors. These significant socio-demographic inequities represent an important starting point for more detailed investigations of places facing the double burden of elevated COVID-19 prevalence and air pollution exposure, and also emphasize the urgent need to develop mitigation strategies for addressing both COVID-19 and chronic air pollution in socially vulnerable communities.