Respiratory Disease and Environmental Justice Burden: A Comparison of Remaining Available Geographic Risk Tools

Introduction: Environmental justice mapping tools have been developed by governmental agencies to provide clear information on the spatial distribution of socio-environmental exposures and the distribution of risk. EJScreen, the nationwide tool created by the Environmental Protection Agency to make such data available, was taken offline by the current administration in February 2025. We explored whether remaining geographic risk tools may be effective in evaluating associations with respiratory disease and compared them with one another. Methods: County-level respiratory disease measures selected for this study include prepandemic asthma, influenza, and respiratory syncytial virus (RSV) hospitalization rates, as well as 2021 COVID-19 mortality rates. Data were regressed using a binary indicator of whether the county meets the definition of a disproportionately impacted community used by Colorado EnviroScreen. Rate ratios and 95% confidence intervals were estimated. Comparability with EnviroScreen was explored for the Social Vulnerability Index (SVI) and the Climate Vulnerability Index (CVI). Results: Higher hospitalization rates for asthma and influenza were identified in counties meeting the criteria for disproportionately impacted communities. Point estimates for RSV hospitalization and COVID-19 mortality were also higher, though not statistically significant. The SVI was found slightly more collinear with EnviroScreen than the CVI with EnviroScreen, although both were highly correlated. Conclusion: Remaining geographic risk tools may aid policymakers and public health agencies in decision-making and resource allocation for respiratory disease, guiding targeted public health campaigns such as mobile vaccination clinics, messaging campaigns, and available testing for infectious respiratory disease in burdened regions.