Spatial Associations of Long-term Exposure to Diesel Particulate Matter with Seasonal and Annual Mortality Due to COVID-19 in the Contiguous United States.

Background People with certain underlying respiratory and cardiovascular conditions might be at an increased risk for severe illness from COVID-19. Diesel Particulate Matter (DPM) exposure may affect the pulmonary and cardiovascular systems. The study aims to assess if DPM was spatially associated with COVID-19 mortality across three waves of the disease and throughout 2020. Methods We tested an ordinary least square (OLS) model, then two global models, spatial lag model (SLM) and spatial error model (SEM), designed to explore spatial dependence, and a geographically weighted regression (GWR) model designed to explore local associations. Results The GWR model found that associations between COVID-19 deaths and DPM concentrations may increase up to 57, 36, 43, and 58 deaths per 100,000 people in some US counties for every 1 µg/m 3 increase in DPM concentration. Relative significant positive association are observed in New York, New Jersey, eastern Pennsylvania, and western Connecticut for the wave from January to May, and in southern Florida and southern Texas for June to September. The period from October to December exhibit a negative association in most parts of the US, which seems to have influenced the year-long relationship due to the large number of deaths during that wave of the disease. Conclusions Our models provided a picture in which long-term DPM exposure may have influenced COVID-19 mortality during the early stages of the disease, but that influence appears to have waned over time as transmission patterns evolved.