Christina S. Boncyk MD, MPH, Sonali Shirali MS, Nicholas Flores-Conner MD, Gen Li MStat, MChem, Jacob C. Clifton MS, Pamela Butler BS, Karen Y. McCarthy EdD, Robert E. Freundlich MD, MS, MSCI
Objective: To study the association between air quality index (AQI) and World Health Organization (WHO) Clinical Progression Scale score following Coronavirus disease 2019 (COVID-19) diagnosis.
Methods: Retrospective study of adults admitted to intensive care units between January 1, 2020 and March 31, 2022 with positive SARS-CoV-2 test. We used proportional odds regression to study association between average AQI over 12 months prior to COVID-19 diagnosis and highest WHO Clinical Progression Scale score on 28th day following ICU admission. As sensitivity analyses, we studied average AQI over 2 months prior and 2 weeks prior to COVID-19 diagnosis.
Results: We identified 1,915 patients with median (IQR) AQI of 37 (33–41). Following regression analysis, a 10-unit increase in average AQI values over the past 12 months prior to COVID-19 diagnosis was associated with reduced odds of having a greater WHO Clinical Progression Scale score (OR 0.84; 95% CI 0.72–0.97; p = 0.02). We failed to detect significant association between AQI and WHO Clinical Progression Scale score (p = 0.26 for 2 months AQI, 0.31 for 2 weeks AQI) within sensitivity analyses.
Conclusions: More specific air quality measurements may more accurately identify those at risk for COVID-19 complications following critical illness.
Keywords: Air quality index critical illness, COVID-19, intensive care units, World Health Organization
Article citation: Boncyk CS, Shirali S, Flores-Conner N, Li G, Clifton JC, Butler P, McCarthy KY, Freundlich RE. Examining the association of social determinants of health on critically ill COVID-19 patient outcomes: A retrospective observational study. The Southwest Journal of Medicine 2025;13(56):8–16
From: Vanderbilt University Medical Center, Nashville, TN (CSB, NF-C, GL, JCC, PB, KYM, REF) Eastern Virginia Medical School, Norfolk, VA (SS)
Submitted: 5/29/2025
Accepted: 6/17/2025
Conflicts of interest: Gen Li owns stock in Johnson & Johnson and Roche Holding AG. Dr. Freundlich owns stock in 3M and has received consulting fees from Phillips Healthcare and Oak Hill Clinical Informatics. Dr. Boncyk is a consultant for Sedana Medical. The other authors declare no competing interests.
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