Determinants of lung health in a vulnerable population burdened by air pollution during the COVID-19 pandemic

Rationale. Jefferson County Alabama, became a U.S. Southeastern cornerstone of industrial mining for coal, iron, and limestone in the 1800's. Coal-fired power plants deposit heavy metals into the air, soil, and water. Residents living in close proximity to these plants are increasingly stricken with lung diseases such as COPD and asthma. Many reside in an area the Environmental Protection Agency (EPA) has requested to be placed on the National Priorities List (NPL). This site has been named the Superfund Research Center (SRC) by the National Institutes of Health (NIH). Air pollution from PM2.5 carrying heavy metals such as cadmium and arsenic have left a legacy of obstructive lung disease in the SRC site. Methods. The American Lung Association “State of the Air” 2020 report, finds parts of Jefferson County remains among the worst in the nation for year-round particle pollution. The Alabama Department of Public Health (ADPH) COVID-19 dashboard was used to identify the number of cases and associated deaths per county in the first four months of the pandemic. The Jefferson County Department of Health, Community Health Equity Report was used to identify demographic and life expectancy reported data. Results. Although African Americans are 29% of the population in Alabama, 45% of the deaths due to COVID-19 are in the African American population, many living within the SRC site. Subjects younger than 50 years of age showed evidence of COPD as compared to those living outside the SRC site. Subjects living in the SRC site also exhibit higher levels of cadmium in their blood than those living outside the site, even if they were nonsmokers. Prior to the pandemic, subjects living within the SRC site had a life expectancy of 60-70 years while other areas with white populations had a life expectancy of 80-90 years. Conclusion. Residents in the SRC are experiencing a cascade of effects that place their lung health at stake. Combine a vulnerable population with varying lung diseases, in a heavily polluted area, with a new onset COVID-19 infection, and an already difficult situation, with pollution induced COPD becomes dire, underscoring the environmental disadvantage the residents face. COVID- 19 has laid bare the disparities in lung health in populations suffering from environmental exposures to toxic air pollution in Jefferson County. Continued efforts in air pollution regulation and continued research and evaluation of the impacts of long-term exposure to air pollution on lung health is the ongoing focus.