{'fraction_non_alphanumeric': 0.02831937133961005, 'fraction_numerical': 0.02149899918452072, 'mean_word_length': 4.8575770733825445, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 1, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Impact of environmental and socio‐economic stressors leading to unequal distribution of COVID‐19 incidences in the state of Louisiana

Abstract Louisiana (LA) ranks fifth in the United States in cancer mortality rate. LA's infamous “cancer alley” is a well evidenced region near the southeast part of the Mississippi river surrounding the petrochemical hub of the state. LA has also experienced a high COVID‐19 death rate and incidences compared to other states during the recent pandemic. In this study we analyzed publicly available datasets related to health and socio‐economic parameters in LA to determine the factors triggering high incidences and deaths caused by COVID‐19. Correlation analysis was performed to find the impact of different parameters on the outcome of COVID‐19. Our analysis showed higher COVID‐19 incidences in the parishes which are in and around the “cancer alley” with a correlation of r = 0.9. Interestingly, results also indicated a strong correlation (r = 0.9) between the death rates caused by asbestos toxicity to COVID‐19 caused death rate. Furthermore, we found that office‐administration related employment has a positive correlation to COVID‐19 incidences in the “cancer alley.” However, we also found both white and black races are equally affected by the COVID‐19 pandemic in the “cancer alley” region. In conclusion, our analysis strongly suggests that inhabiting “cancer alley” could significantly enhance the chances of getting affected by SARS‐CoV‐2 virus compared to other regions in LA.


BACKGROUND
The State of Louisiana is situated along the Gulf of Mexico. The State has been making daily news headlines because of the high number of COVID-19 related incidences and deaths during the recent pandemic.
In the last year, 10 Louisiana parishes were placed among the top 25 counties in the entire country for having the highest COVID-19 cases per 100,000 people. This intrigued the authors of this paper to figure out the reason for such a huge outbreak in the state of Louisiana. While Louisiana is the 2 nd poorest state in the United States, this state also stands 2 nd in the nation in the percentage of African American population (census.gov).
The state of Louisiana is experiencing higher incidence rate of COVID-19 cases per capita, and more than one parish in Louisiana are in the headlines for having multiple parishes that have higher COVID-19 incidence rates than the national average (Mollalo et al., 2021  National Air Toxics Assessment, inhabitants of cancer alley possess risk getting cancer from air pollution at a rate of 95% higher than the most Americans. Cancer alley is located along the Mississippi River between Baton Rouge and New Orleans containing a multitude of industrial plants (Rosenfeld & Feng, 2011). This area has more clusters of cancer patients than anywhere else in the state. The state of LA is also home to chemical processing industries and petroleum refineries.
Most refineries are located within miles of residential units.  (Carroll et al., 2017). Most of the households in cancer alley are found to be economically challenged, and some of the representative parishes within cancer alley have a significantly higher percentage of African American population than other parishes. It has also been mentioned by the environmental protection agency (EPA) that some of the plant cities in cancer alley are "likely carcinogenic" (Groves et al., 1996). A study by Tsai et al. (2004), found little evidence of association between cancer incidence and employment at two petrochemical areas in South Louisiana and concluded that an increase in bone cancer in he employees of these two facilities might not have occurred due to the employment at these two facilities.
There has been mixed and inconclusive evidence in the literature regarding Louisiana's air expo-sure to chemical emissions. Since crude oil has been the most important source of energy since the mid-1950s, the petrochemical industries produce derivatives of crude oil and involve refining and cracking. Air pollutants like sulphur oxides, nitrogen oxides, carbon monoxide and dioxide, volatile organic compounds (VOCs), some of which are carcinogenic, are common environmental emissions of petrochemical industries (Domingo et al., 2020).
Thus far there has been inconclusive evidence for Louisiana where a clear and positive correlation can be shown between residential proximity to petrochemical industries and lung cancer. However, Gottlieb et al. (1982), concluded some evidence between proximity of petrochemical industries in Louisiana and lung cancer in the residents, based on the data obtained from 1960 through 1975.
The known sources of environmental pollutants are the petrochemical complexes and oil refineries anywhere in the world (Lin et al., 2018). Recently published studies have emphasized that aerosol concentration and its sustenance in air are higher in areas that have high concentration of (particulate matter) PM 2.5, NO 2 , SO 2 in the air.
One such study by Frontera et al. (2020)  with Covid 19 mortality rates. Another study by Wang et al. (2020), analyzed the satellite data for assessing the air pollution and found that COVID-19 fatality increased with increase in 1% CO 2 emission. This study emphasized that reduction in CO 2 emitting activities would be beneficial for a reduction of COVID-19 mediated fatalities and therefore would be beneficial for public health. Yet another 2020 study con-ducted by Wu et al. (2020), evidenced that if the long term average of PM 2.5 is increased by 1 µg/m3 then it is is associated with a statistically significant 11% (95% CI, 6 to 17%) increase in the county's

Data collection
Age standardized COVID-19 incidence rate per 100,000 population in LA parishes were obtained from the CDC (cdc.gov). We have also included lung/bronchus, thyroid, and colon cancer cases (available from LA cancer registry), asbestos exposure mediated death (CDC wonder database), and cases of chronic obstructive pulmonary disorders (COPD) and asthma (CDC) in the selected parishes. We have analyzed the COVID-19 incidences in LA parishes based on rates per 100,000 population. We sorted the parishes with highest (13 parishes) and lowest (10 parishes) incidences of COVID-19 in LA (Exhibit 2). These two groups of parishes were created with the lowest and highest incidences to further analyze associated factors which might have a direct or indirect effect on COVID-19 cases.
Our analysis also included socio-economic factors such as poverty rate, ethnic group data, education, employment type, and percentage from each of the selected parishes. The socio-economic data were collected from US census tract data.

Statistical analysis
Correlation analysis was conducted on the data set using R (Larsen & Marx, 2018). The null hypothesis is as follows: 1. There is a lack of evidence of association between the two variables (independence), 2. The variables are associated (dependence).
The significance level is taken to be 0.05. That is, at this level, we reject the null hypothesis and there is evidence of an association. The Pearson correlation matrix was computed in R using the "rcorr" function, which is part of the "Hmisc" package. For simulation purposes the parishes were encoded 0 and 1 for a parish located outside and inside the cancer alley region, respectively. The results are displayed graphically in Exhibits 3-6.

Data visualization
The visualization for this task is done by using the Plotly package of Python. We explored Plotly-database for obtaining information on each state of the United States and their corresponding country information. To visualize each country of Louisiana we have used three Python packages named geopandas, pyshp, and shapely for color coding.

RESULTS
The lung cancer rate in LA (66.6 people among 100,000) is much higher than the national rate of lung cancer, that is, 58.8 (out of 100,000 people). We have sorted the LA parishes on the basis of highest incidences of lung cancer (rates per 100,000 population). Exhibit 7 represents the top 13 parishes in LA on the basis of lung cancer rates. Since LA has the 3rd highest incidence rate of colon cancers in the United States, we ranked the top 13 parishes in LA based on higher rates of colon cancer.
These parishes are listed in Exhibit 8.
Next, we ranked the parishes with highest (13 parishes) and lowest (10 parishes) incidences of COVID-19 in We have further demonstrated the socio-economic and environmental parameters in the lowest and highest COVID-19 occurring parishes in Exhibit 9 for better understanding. We have included the racial data (white and black), poverty rate, educational level, and major occupation in each of these parishes. Interestingly, we also found a strong correlation (r = 0.9) between the asbestos related death rate to COVID-19 death rate. We also found that office-administration related employment has a positive correlation to COVID incidences in the cancer alley. We found both Caucasian and African American races are equally affected by the COVID-19 pandemic in the cancer alley region.

E X H I B I T 5 Analysis of environmental factors [Color
Finally, we demonstrate the visual representation of the selected Parishes in this study which are either near to the cancer alley with increased incidences of COVID-19 or located outside cancer alley with a lower number of COVID-19 incidences. Figure 6 shows the parishes with highest COVID-19 incidences as yellow color coded whereas the green color coded refer to the lowest COVID-19 incidences.
We further coded red to depict the parishes with higher COVID-19 incidences which are geographically located in and around Cancer Alley.

E X H I B I T 6
Analysis of socioeconomic parameters [Color figure can be viewed at wileyonlinelibrary.com]

DISCUSSION
Louisiana (LA) has experienced a disproportionate distribution of COVID-19 cases throughout the state. While some parishes in LA were ranked among the most severely affected by COVID-19 pandemic in the United States, at the same time some areas were among the least affected. Our analysis indicated that the parishes in or around the infamous cancer alley region have significantly accounted for higher amounts of COVID-19 cases compared to the rest of the state.
Previous reports have shown that cancer alley is infested with several industries and plants which are responsible for the high concentration of industrial zones in a stretch of 85 miles. This area has been found to have increased over the last 10-15 years as well, which increased the severity of diseases in those areas including, cancer, COPD, and metabolic diseases.
Previous studies, although few, have indicated an impact of social disparity in the cancer alley being a major force triggering the incidences of cancer. In our study we indeed found poverty to be a significant factor as almost half of the parishes in the cancer alley region have a higher poverty level than the Parishes which have lower COVID-19 cases. A few studies have indicated race to be a predictor of higher incidences of COVID-19 (Sarkar et al., 2021). We strongly refute this point, and it seems one of the most prominent findings of our work. Race was not established as a factor that predicted the outcome of COVID-19 fatality in the selected parishes in our study. Having almost equal amounts of African Americans in both the high fatality and low fatality parishes in Louisiana resulted in a negative correlation between race and COVID-19 fatality.
We did not find a strong correlation between asthma and COVID-19 risk. There are a few other studies, similar to us, that have not through polluted air and water, resulting in alarmingly high statistics of cancer cases (Iqbal et al., 2007;Fos et al., 2021;Presley et al., 2010). We emphasized on another strong finding of this study which is the correlation between lung cancer cases and COVID-19 fatalities.
There was a positive correlation between these two, especially in the parishes that are in cancer alley. Historically, these parishes are also high in poverty rate and therefore might lack the necessary medical care that help them avoid cancer. Nevertheless, the existence of toxic air does not seem inevitable due to the location of 150 petrochemical companies. Interestingly, there have not been a lot of studies that focused on assessing the air quality of cancer alley, such as the density of lung pollutants but anecdotal studies do focus on the poor air quality assessment of cancer alley (Rosenfeld & Feng, 2011 workers remain home bound and in many industries social distancing was employed strictly implemented. However, office workers in medical facility or dental facility or offices where social distancing is not well maintained, in these circumstances' employees were more prone to be infected with COVID-19 incidences (Zhang, 2020). Another study by Baker et al. (2020), also found that individuals in office administrations are among the top employment categories which were exposed more to COVID-19, which again correlated to out finding as well.
Office administration employee could include, medical office secretaries, patient appointment schedulers, etc.
The animated Louisiana (Exhibit 10) map shows that the parishes with highest COVID-19 cases are residing in cancer alley or are very E X H I B I T 9 Tabular representation of socio-economic data in lowest and highest COVID-19 occurring data in different parishes