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Environmental Health

Assessment of Exposure to Environmental Toxins and Racial and Ethnic Disparities in COVID-19 Hospitalizations Among US Veterans

Educational Objective
To identify the key insights or developments described in this article

1 Credit CME

JAMA Network Open

Published Online: July 28, 2022

Research Letter

Article Information and Disclosures

Michelle S. Wong, PhD¹;

W. Neil Steers, PhD¹;

Stephen Frochen, PhD¹;

Donna L. Washington, MD, MPH^1,2

Author Affiliations

¹Veterans Affairs Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation, and Policy, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
²Division of General Internal Medicine and Health Services Research, Department of Medicine, Geffen School of Medicine, University of California, Los Angeles, Los Angeles

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Residential neighborhood social factors associated with health play a role in the disproportionate impact of the COVID-19 pandemic among racial and ethnic minority populations.¹ Exposure to environmental toxins has been understudied as a relevant neighborhood factor associated with health. Structural racism has relegated racial and ethnic minority populations to residential communities with higher, and multiple, risks of exposure to environmental toxins (eg, communities near industrial facilities).² Although this exposure may be associated with increases in COVID-19–related comorbidities (eg, cancers),³^,4 which might explain some of the racial and ethnic disparities in outcomes, it is unknown whether exposure to environmental toxins is independently associated with increases in COVID-19 susceptibility. This cohort study examined the hypothesis that exposure to environmental toxins mediates the association of racial and ethnic disparities with hospitalizations among veterans with COVID-19 after accounting for individual-level risk factors and comorbidities.

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Article Information

Accepted for Publication: June 12, 2022.

Published: July 28, 2022. doi:10.1001/jamanetworkopen.2022.24249

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2022 Wong MS et al. JAMA Network Open.

Corresponding Author: Michelle S. Wong, PhD, Veterans Affairs Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation, and Policy, Veterans Affairs Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, Bldg 206, Los Angeles, CA 90073 (michelle.wong6@va.gov).

Author Contributions: Drs Wong and Washington had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Wong, Frochen, Washington.

Acquisition, analysis, or interpretation of data: Wong, Steers, Washington.

Drafting of the manuscript: Wong, Steers.

Critical revision of the manuscript for important intellectual content: Steers, Frochen, Washington.

Statistical analysis: Wong, Steers.

Obtained funding: Washington.

Administrative, technical, or material support: Wong, Frochen, Washington.

Supervision: Washington.

Conflict of Interest Disclosures: Dr Wong reported receiving grants from the Veterans Health Administration during the conduct of the study. Dr Frochen reported receiving grants from the Veterans Affairs (VA) Office of Academic Affiliation (via a fellowship from VA Health Services Research and Development Service at the VA Greater Los Angeles Healthcare System) during the conduct of the study. Dr Washington reported receiving grants from the Veterans Health Administration during the conduct of the study. No other disclosures were reported.

Funding/Support: This work was supported by grant SDR-20-402 from the VA Health Services Research and Development Service (Dr Washington) and grant PEC-15-239 from the Office of Health Equity and the Quality Enhancement Research Initiative (Dr Washington via the VA Health Equity and Quality Enhancement Research Initiative national partnered evaluation center).

Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Disclaimer: The views expressed in this article represent those of the authors and do not necessarily represent the views of the US Department of Veterans Affairs or the United States Government.

Additional Contributions: The authors thank Anita Yuan, PhD, of the VA Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, for her help in obtaining the data for this analysis. Dr Yuan was employed as a data analyst on the grants supporting these analyses at the time of this study.

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 credit toward the CME [and Self-Assessment requirements] of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.