Built environment's impact on COVID-19 transmission and mental health revealed by COVID-19 Participant Experience data from the All of Us Research Program

ObjectivesThe coronavirus disease 2019 (COVID-19) pandemic has led to millions of deaths. Effectively cutting the transmission of COVID-19 is essential to reduce the impact. Previous studies have observed the potential relationship between the built environment and COVID-19 transmission; however, to date, stringent studies investigating these relationships at the individual level are still insufficient. Here, we aim to examine the relationship between household types and COVID-19 infection (or mental health) during the early stages of the pandemic by using the All of Us Research Program COVID-19 Participant Experience (COPE) survey data. DesignBased on 62,664 participants responses to COPE from May to July 2020, we matched the cases of self-reported COVID-19 status, anxiety, or stress, with controls of the same race, sex, age group, and survey version. We conducted multiple logistic regressions between one of the outcomes and household type under the adjustment of other related covariates, such as ethnicity, age, social distancing behavior, and house occupancy. ResultsHousehold type with a shared component was significantly associated with COVID-19 infection (OR=1.19, 95% CI 1.1 to 1.3; p=2x10-4), anxiety (OR=1.26, 95% CI 1.1 to 1.4; p=1.1x10-6), and stress (OR=1.29, 95% CI 1.2 to 1.4, p=4.3x10-10) as compared to free-standing houses after adjusting for the abovementioned confounding factors. Further, frequent nonessential shopping or outings, another indicator of the built environment, was also associated with COVID-19 infection (OR=1.36, 95% CI 1.1 to 1.8; p=0.02), but not associated with elevated mental health conditions. ConclusionOur study demonstrated that the built environment of houses with a shared component tends to increase the risk of COVID-19 transmission, which consequently led to more anxiety and stress for their dwellers. It also suggested the necessity to improve the quality of the built environment through planning, design, and management toward a more resilient society in coping with future pandemics.