One-third of adults 65 yrs old and older admitted to the intensive care unit die within 6 months of hospital discharge. Among survivors at 6 months, health-related quality of life has significantly worsened over time in the oldest patients but improved in the youngest. Our study in a large cohort of mixed intensive care unit patients identifies additional prognostic factors and significant quality of life information in intensive care unit survivors well after hospital discharge. This additional information may guide clinicians in their discussions with patients, families, and other providers as they decide on what treatments and interventions to pursue.

Rationale: Risk factors for COVID-19 mortality may include environmental exposures, such as air pollution.Objectives: Determine whether, amongst adults hospitalized with PCR-confirmed COVID-19, long-term air pollution exposure is associated with risk for mortality, intensive care unit (ICU) admission or intubation. Methods:We performed a retrospective analysis of SARS-CoV-2 PCR positive patients admitted to seven New York City hospitals from March 8, 2020 to August 30, 2020. The primary outcome was mortality; secondary outcomes were ICU admission and intubation. We estimated the annual average fine particulate matter (PM 2.5 ), nitrogen dioxide (NO 2 ) and black carbon (BC) concentrations at patients' residential addresses. We employed double-robust Poisson regression to analyze associations between annual average PM 2.5 , NO 2 and BC exposure and COVID-19 outcomes, adjusting for age, sex, race/ethnicity, hospital, insurance and time from onset of the pandemic.Results: Of the 6,542 patients, 41% were female and aged median 65 years (IQR 53, 77). Over 50% selfidentified as a person of color [N=1,687 (26%) Hispanic, N=1,659 (25%) Black]. Air pollution exposures were generally low. Overall, 31% (N=2,044) of the cohort died, 19% (N=1,237) were admitted to the ICU and 16% (1,051) were intubated. In multivariable models, higher long-term exposure to PM 2.5 was associated with increased risk of mortality (RR 1.11, 95% CI 1.02, 1.21 per 1µg/m 3 increase in PM 2.5 ) and ICU admission (RR 1.13, 95% CI 1.00, 1.28 per 1µg/m 3 increase in PM 2.5 ). In multivariable models, neither NO 2 nor BC exposure was associated with COVID-19 mortality, ICU admission or intubation.Conclusions: Amongst patients hospitalized with COVID-19, higher long-term PM 2.5 exposure was associated with increased risk of mortality and ICU admission.