Impact of COVID-19 related stay-at-home orders on traffic, traffic-related air pollution, and cardiovascular health in New York City

PROJECT SUMMARY/ABSTRACT Globally, air pollution is responsible for an estimated 4.2 million deaths per year. In New York City (NYC), traffic-related air pollution (TRAP) contributes to an estimated 320 deaths and 870 hospitalizations per year and is associated with increased risk of stroke and myocardial infarction (MI); additionally, lower socioeconomic status (SES) groups face a higher burden. Stay-at-home orders in response to the coronavirus disease (COVID- 19) pandemic can be thought of as a traffic intervention policy; it has impacted traffic congestion and TRAP at an unprecedented level. However, this change has not been assessed at fine spatio-temporal resolution in NYC, challenging the epidemiologic study of its impact on stroke and MI, including variation by SES and chronic disease burden (CDB; i.e., proportion of people with hypertension, diabetes, obesity). During the pandemic, substantial decreases in emergency department visits for stroke and MI, which can be triggered by TRAP, have been observed. While this decrease is likely driven in part by reduced care seeking, given known associations between TRAP and stroke/MI, the large decreases in TRAP likely contributed to this decline. However, this has not yet been investigated in NYC. Additionally, given that the vehicle fleet composition has likely shifted during the pandemic (e.g., proportionally more delivery trucks), the relationship between congestion, TRAP, and stroke/MI during the pandemic is not known. To address these gaps, this proposal will: (1) evaluate the impact of stay-at-home orders related to the COVID-19 pandemic on (A) traffic congestion and (B) TRAP in NYC; and assess variation in congestion by indices of SES and CDB; (2) estimate the number of acute TRAP-associated stroke and MI hospitalizations expected to be prevented by altered TRAP during the pandemic, compare to total observed changes in stroke/MI hospitalizations, and assess variability by SES and CDB; and (3) (exploratory) investigate the associations between congestion, TRAP, stroke, and MI hospitalizations during the pandemic. The main goal of the training plan is to provide the applicant with the skills, expertise, and experience to conduct rigorous public health research in the field of environmental epidemiology, with a focus in air pollution and health disparities research. The training plan includes a mix of formal didactic training, applied research experience, professional development, and oral presentation opportunities. It will focus on the following training priorities: (1) causal inference; (2) environmental health disparities; (3) air pollution exposure assessment for large-scale health studies; (4) strategies for oral communication of science; (5) advanced biostatistical methods for environmental health sciences; and (6) training in grant writing, design, and management. The environment of Columbia University Mailman School of Public Health is ideal for the proposed project, given the school's commitment to training students, exceptional expertise and resources available in environmental health sciences and environmental epidemiology, and the unparalleled mentorship team assembled for this proposal.