ArticleThe Science of the total environment2021
An external exposome-wide association study of COVID-19 mortality in the United States.
Article in The Science of the total environment, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 25 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
25 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- The impact of air pollution on COVID-19 incidence, severity, and mortality: A systematic review of studies in Europe and North America.Environmental research · 2022Pooled it
- Relationship between Autism Spectrum Disorder and Pesticides: A Systematic Review of Human and Preclinical Models.International journal of environmental research and public health · 2021Pooled it
- Large-scale assessment of socioeconomic, demographic and health system structures with US county excess mortality, 2020-2024.medRxiv : the preprint server for health sciences · 2026Article
- External Exposome Factors and Adverse Heart Failure Outcomes in the OneFlorida+ Network: Retrospective Cohort Study.JMIR formative research · 2025Article
- Article
- Integrative multi-omics analysis to gain new insights into COVID-19.Scientific reports · 2024Article
- A fair individualized polysocial risk score for identifying increased social risk in type 2 diabetes.Nature communications · 2024Article
- Identifying Potential Factors Associated With Racial Disparities in COVID-19 Outcomes: Retrospective Cohort Study Using Machine Learning on Real-World Data.JMIR public health and surveillance · 2024Article
- Socioexposomics of COVID-19 across New Jersey: a comparison of geostatistical and machine learning approaches.Journal of exposure science & environmental epidemiology · 2024Article
- A Fair Individualized Polysocial Risk Score for Identifying Increased Social Risk in Type 2 Diabetes.Research square · 2023Article
- Enriching Real-world Data with Social Determinants of Health for Health Outcomes and Health Equity: Successes, Challenges, and Opportunities.Yearbook of medical informatics · 2023Article
- Mapping the long-term associations between air pollutants and COVID-19 risks and the attributable burdens in the continental United States.Environmental pollution (Barking, Essex : 1987) · 2023Article
- A spatial and contextual exposome-wide association study and polyexposomic score of COVID-19 hospitalization.Exposome · 2023Article
- An external exposome-wide association study of opioid use disorder diagnosed during pregnancy in Florida.The Science of the total environment · 2023Article
- Identifying environmental risk factors for post-acute sequelae of SARS-CoV-2 infection: An EHR-based cohort study from the recover program.Environmental advances · 2023Article
- Methodological Challenges in Spatial and Contextual Exposome-Health Studies.Critical reviews in environmental science and technology · 2023Article
- Modifiable contributing factors to COVID-19: A comprehensive review.Food and chemical toxicology : an international journal published for the British Industrial Biological Research Association · 2023Review
- Identifying Contextual and Spatial Risk Factors for Post-Acute Sequelae of SARS-CoV-2 Infection: An EHR-based Cohort Study from the RECOVER Program.medRxiv : the preprint server for health sciences · 2022Article
- Environmental effects on acute exacerbations of respiratory diseases: A real-world big data study.The Science of the total environment · 2022Article
- Contributing factors common to COVID‑19 and gastrointestinal cancer.Oncology reports · 2022Review
Corrections and comments
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Authors and funding
9 authors.
Funding
Abstract
The risk factors for severe COVID-19 beyond older age and certain underlying health conditions are largely unknown. Recent studies suggested that long-term environmental exposures may be important determinants of severe COVID-19. However, very few environmental factors have been studied, often separately, without considering the totality of the external environment (i.e., the external exposome). We conducted an external exposome-wide association study (ExWAS) using the nationwide county-level COVID-19 mortality data in the contiguous US. A total of 337 variables characterizing the external exposome from 8 data sources were integrated, harmonized, and spatiotemporally linked to each county. A two-phase procedure was used: (1) in Phase 1, a random 50:50 split divided the data into a discovery set and a replication set, and associations between COVID-19 mortality and individual factors were examined using mixed-effect negative binomial regression models, with multiple comparisons addressed, and (2) in Phase 2, a multivariable regression model including all variables that are significant from both the discovery and replication sets in Phase 1 was fitted. A total of 13 and 22 variables were significant in the discovery and replication sets in Phase 1, respectively. All the 4 variables that were significant in both sets in Phase 1 remained statistically significant in Phase 2, including two air toxicants (i.e., nitrogen dioxide or NO
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