# The External Exposome and COVID-19 Severity

> **NIH NIH R21** · UNIVERSITY OF FLORIDA · 2021 · $1

## Abstract

PROJECT SUMMARY
The 2019 novel coronavirus disease (COVID-19) is a global pandemic with severe medical and socioeconomic
consequences. Young adults without any underlying health conditions can still develop severe COVID-19
disease, and there are racial and ethnic disparities in COVID-19 hospitalization and mortality rates which
cannot be explained by age and underlying health conditions alone. Risk factors of severe COVID-19 beyond
older age and underlying health conditions are large unknown. There are large overlaps between the currently
known risk factors of severe COVID-19 and the health conditions that are affected by environmental
exposures, and emerging evidence suggested that long-term environmental exposures may be important
determinants of COVID-19 severity. Traditional environmental epidemiological studies usually examine
environmental factors separately without considering “the totality of the external environment”. Such studies
are not only time consuming as they examine individual exposures separately, but more importantly, cannot
account for confounding by co-exposures. The external exposome is an ideal framework to identify novel
exposures associated with severe COVID-19 as it can systematically and efficiently screen thousands of
environmental exposures. In this project, we will leverage a unique real-world data (RWD) resource –
OneFlorida – a large repository of linked electronic health records (EHR), claims and vital statistics data,
covering more than 60% of Floridians, contributing to the national Patient-Centered Clinical Research Network
(PCORnet). Building on our prior work on the external exposome, we will expand our existing external
exposome database to include additional factors that may impact COVID-19 outcomes through a systematic
analysis of literature and resources. We aim to (1) develop phenotyping algorithms for identifying a COVID-19
cohort and their severity and extracting associated individual-level risk factors from the OneFlorida real-world
data, and (2) identify external exposome factors associated with severe COVID-19, examine how the external
exposome contributes to racial and ethnic disparities in severe COVID-19, and build predictive models of
severe COVID-19 with external exposome factors. This study will fill important knowledge gaps by providing
timely information to understand how environmental exposures may impact COVID-19 severity that will
improve identifications of high-risk COVID-19 patients and inform the design of future precision interventions.
Our approach and initial results for Florida can (1) be readily scaled up to a multi-state study through PCORnet
and (2) answer other novel questions such as the external exposome’s contribution to geographic disparities in
COVID-19 outcomes.

## Key facts

- **NIH application ID:** 10240752
- **Project number:** 5R21ES032762-02
- **Recipient organization:** UNIVERSITY OF FLORIDA
- **Principal Investigator:** Jiang Bian
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $1
- **Award type:** 5
- **Project period:** 2020-08-20 → 2021-09-06

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10240752

## Citation

> US National Institutes of Health, RePORTER application 10240752, The External Exposome and COVID-19 Severity (5R21ES032762-02). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10240752. Licensed CC0.

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