An Ecologic Study of Disparities in COVID-19 Incidence and Case Fatality in Oakland County, MI, USA, During a State-Mandated Shutdown

What have we learned about socioeconomic inequalities in the spread of COVID-19? A systematic review

This article aims to provide a better understanding of the associations between groups of socioeconomic variables and confirmed cases of COVID-19. The focus is on cross-continental differences of reported positive, negative, unclear, or no associations. A systematic review of the literature is conducted on the Web of Science and SCOPUS databases. Our search identifies 314 eligible studies published on or before 31 December 2021. We detect nine groups of frequently used socioeconomic variables and results are presented by region of the world (Africa, Asia, Europe, Middle East, North American and South America). The review expands to describe the most used statistical and modelling techniques as well as inclusion of additional dimensions such as demographic, healthcare weather and mobility. Meanwhile findings agree on the generalized positive impact of population density, per capita GDP and urban areas on transmission of infections, contradictory results have been found concerning to educational level and income.

Missing science: A scoping study of COVID-19 epidemiological data in the United States

Systematic approaches to epidemiologic data collection are critical for informing pandemic responses, providing information for the targeting and timing of mitigations, for judging the efficacy and efficiency of alternative response strategies, and for conducting real-world impact assessments. Here, we report on a scoping study to assess the completeness of epidemiological data available for COVID-19 pandemic management in the United States, enumerating authoritative US government estimates of parameters of infectious transmission, infection severity, and disease burden and characterizing the extent and scope of US public health affiliated epidemiological investigations published through November 2021. While we found authoritative estimates for most expected transmission and disease severity parameters, some were lacking, and others had significant uncertainties. Moreover, most transmission parameters were not validated domestically or re-assessed over the course of the pandemic. Publicly available disease surveillance measures did grow appreciably in scope and resolution over time; however, their resolution with regards to specific populations and exposure settings remained limited. We identified 283 published epidemiological reports authored by investigators affiliated with U.S. governmental public health entities. Most reported on descriptive studies. Published analytic studies did not appear to fully respond to knowledge gaps or to provide systematic evidence to support, evaluate or tailor community mitigation strategies. The existence of epidemiological data gaps 18 months after the declaration of the COVID-19 pandemic underscores the need for more timely standardization of data collection practices and for anticipatory research priorities and protocols for emerging infectious disease epidemics.

Access, socioeconomic environment, and death from COVID-19 in Nebraska

Our study assesses whether factors related to healthcare access in the first year of the pandemic affect mortality and length of stay (LOS). Our cohort study examined hospitalized patients at Nebraska Medicine between April and October 2020 who were tested for SARS-CoV-2 and had a charted sepsis related diagnostic code. Multivariate logistic was used to analyze the odds of mortality and linear regression was used to calculate the parameter estimates of LOS associated with COVID-19 status, age, gender, race/ethnicity, median household income, admission month, and residential distance from definitive care. Among 475 admissions, the odds of mortality is greater among those with older age (OR: 1.04, 95% CI: 1.02-1.07) and residence in an area with low median household income (OR: 2.11, 95% CI: 0.52-8.57), however, the relationship between mortality and wealth was not statistically significant. Those with non-COVID-19 sepsis had longer LOS (Parameter Estimate: -5.11, adjusted 95% CI: -7.92 to -2.30). Distance from definitive care had trends toward worse outcomes (Parameter Estimate: 0.164, adjusted 95% CI: -1.39 to 1.97). Physical and social aspects of access to care are linked to poorer COVID-19 outcomes. Non-COVID-19 healthcare outcomes may be negatively impacted in the pandemic. Strategies to advance patient-centered outcomes in vulnerable populations should account for varied aspects (socioeconomic, residential setting, rural populations, racial, and ethnic factors). Indirect impacts of the pandemic on non-COVID-19 health outcomes require further study.

Population Mobility and Aging Accelerate the Transmission of Coronavirus Disease 2019 in the Deep South: A County-Level Longitudinal Analysis

Population mobility and aging at local areas contributed to the geospatial disparities in the coronavirus disease 2019 (COVID-19) transmission among 418 counties in the Deep South. In predicting the incidence of COVID-19, a significant interaction was found between mobility and the proportion of older adults. Effective disease control measures should be tailored to vulnerable communities.

Racial Disparities in COVID-19 Impacts in Michigan, USA

Racial disparities have been observed in the impacts of COVID-19 in the USA. In the present paper, we used a representative sample of adults in Michigan to examine differences in COVID-19 impacts on Blacks and Whites in four domains: direct, perceived, political, and behavioral. We found that in the initial wave of the outbreak in May 2020, Blacks experienced more severe direct impacts: they were more likely to be diagnosed or know someone who was diagnosed, and more likely to lose their job compared to Whites. In addition, Blacks differed significantly from Whites in their assessment of COVID-19's threat to public health and the economy, the adequacy of government responses to COVID-19, and the appropriateness of behavioral changes to mitigate COVID-19's spread. Although in many cases these views of COVID-19 were also associated with political ideology, this association was significantly stronger for Whites than Blacks. Continued investigation of racial disparities in COVID-19's impact is necessary; however, these preliminary findings of a race-by-ideology interaction are important because they suggest some racial disparities are restricted to conservatives, while more liberal Whites and Blacks exhibit few differences.

Social Determinants of Disease: HIV and COVID-19 Experiences

PURPOSE OF REVIEW

The differential impact of the COVID-19 and HIV pandemics on marginalized communities has renewed calls for more robust and deeper investigation into structural and social causes of health inequities contributing to these infections, including underlying factors related to systematic racism. Using the Social Determinants of Health (SDOH) framework, we analyzed parallel and divergent factors associated with COVID-19 and HIV/AIDS and the prevalence of disparate disease in diverse communities. We utilized PRISMA guidelines to identify relevant literature (N = 210 articles) that resulted in a review of 125 articles included in our synthesis.

RECENT FINDINGS

With racial health inequities as a core contributor to disease vulnerability, we also identified other factors such as economic stability, social and community support, the neighborhood and built environment, healthcare access and quality, and education access and quality as important socioecological considerations toward achieving health equity. Our review identifies structural and systematic factors that drive HIV and COVID-19 transmission. Our review highlights the importance of not solely focusing on biomedical interventions as solutions to ending HIV and COVID-19, but rather call for building a more just public health and social service safety net that meets the needs of people at the intersection of multiple vulnerabilities.

Outcomes of Covid 19 patients-Are Hispanics at greater risk?

Disparities in outcomes exist in outcomes of coronavirus disease‐19 (COVID‐19). Little is known about other ethnic minorities in United States. We included all COVID‐19 positive adult patients (≥18 years) hospitalized between March 1, 2020 and February 5th 2021. We compared in hospital mortality, use of intensive care unit services and inflammatory markers between non‐Hispanic whites with non‐White/Black Hispanic. Multivariable Cox proportional Hazard models were used to adjust for differences between the two groups. There were 4059 hospital admissions with COVID‐19 in the study period. Of the 3288 White, 789 (24%) required intensive care unit (ICU) admission in comparison to 187 (24.3%) of the 770 Hispanics. Unadjusted mortality was higher in Whites than Hispanics (17.1% vs. 10.7%; p < 0.001). After adjusting for confounding variables, in‐hospital mortality was not statistically different for Whites in comparison to Hispanics (hazard ratio [HR]: 0.96, 95% confidence interval [CI]: 0.76–1.21, p = 0.73). The adjusted rates of ICU transfers were significantly higher in Hispanics (HR: 1.34, 95% CI: 1.11–1.61, p = 0.002). Hispanics had significantly higher C‐reactive protein, lactate dehydrogenase, and fibrinogen when compared to Whites. Hispanics as compared to Whites with COVID‐19 require higher rates of ICU admission but have a similar mortality. Hispanics as compared to Whites with COVID‐19 require higher rates of ICU admission but have a similar mortality.

Association between community-based self-reported COVID-19 symptoms and social deprivation explored using symptom tracker apps: a repeated cross-sectional study in Northern Ireland

OBJECTIVES

The aim of the study was to investigate the spatial and temporal relationships between the prevalence of COVID-19 symptoms in the community-level and area-level social deprivation.

DESIGN

Spatial mapping, generalised linear models, using time as a factor and spatial-lag models were used to explore the relationship between self-reported COVID-19 symptom prevalence as recorded through two smartphone symptom tracker apps and a range of socioeconomic factors using a repeated cross-sectional study design.

SETTING

In the community in Northern Ireland, UK. The analysis period included the earliest stages of non-pharmaceutical interventions and societal restrictions or 'lockdown' in 2020.

PARTICIPANTS

Users of two smartphone symptom tracker apps recording self-reported health information who recorded their location as Northern Ireland, UK.

PRIMARY OUTCOME MEASURES

Population standardised self-reported COVID-19 symptoms and correlation between population standardised self-reported COVID-19 symptoms and area-level characteristics from measures of multiple deprivation including employment levels and population housing density, derived as the mean number of residents per household for each census super output area.

RESULTS

Higher self-reported prevalence of COVID-19 symptoms was associated with the most deprived areas (p<0.001) and with those areas with the lowest employment levels (p<0.001). Higher rates of self-reported COVID-19 symptoms within the age groups, 18-24 and 25-34 years were found within the most deprived areas during the earliest stages of non-pharmaceutical interventions and societal restrictions ('lockdown').

CONCLUSIONS

Through spatial regression of self-reporting COVID-19 smartphone data in the community, this research shows how a lens of social deprivation can deepen our understanding of COVID-19 transmission and prevention. Our findings indicate that social inequality, as measured by area-level deprivation, is associated with disparities in potential COVID-19 infection, with higher prevalence of self-reported COVID-19 symptoms in urban areas associated with area-level social deprivation, housing density and age.

COVID-19 fatalities by zip codes and socioeconomic indicators across various U.S. regions

Background

There is a paucity of literature addressing COVID-19 case-fatality ratios (CFR) by zip code (ZC). We aim to analyze trends in COVID-19 CFR, population density, and socioeconomic status (SES) indicators (unemployment, median household income) to identify ZCs heavily burdened by COVID-19.

Methods

Cross-sectional study to investigate the US prevalence of COVD-19 fatalities by ZC and SES. CFRs were calculated from state/county Departments of Health. Inclusion criteria were counties that reported cases/deaths by ZC and a CFR≥2%. This study was reported in line with the STROCSS criteria.

Results

609/1,853 ZCs, spanning 327 counties in 7 states had CFRs ≥2%. A significant positive correlation was found between the CFR and median household income (Pearson correlation:0.107; 95% CI [289.1,1937.9]; p < 0.001). No significant correlations exist between the CFR, and population/mi (Sen-Crowe et al., 2020) [2] or unemployment rate. Significant associations exist between the CFR and young males and elderly females without public insurance. CFR was inversely associated with persons aged <44 and individuals aged ≥65. The percentage of nursing homes (NHs) within cities residing within high CFR ZCs range from 8.7% to 67.6%.

Conclusion

Significant positive association was found between the CFR and median household income. Population/mi (Sen-Crowe et al., 2020) [2] and unemployment rates, did not correlate to CFR. NHs were heavily distributed in high CFR zip codes. We recommend the targeted vaccination of zip codes with a large proportion of long-term care facilities. Finally, we recommend for improved screening and safety guidelines for vulnerable populations (e.g nursing home residents) and established protocols for when there is evidence of substantial infectious spread.

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First national sampling of COVID-19 Case Fatality Ratio (CFR) at the zip code level.

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Population density and unemployment rate did not correlate to COVID-19 CFR.

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Significant positive correlation was found between CFR and median household income.

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Nursing homes were concentrated in zip codes with high COVID-19 CFR.

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States should make COVID-19 data available at the zip code level.

Actual Racial/Ethnic Disparities in COVID-19 Mortality for the Non-Hispanic Black Compared to Non-Hispanic White Population in 35 US States and Their Association with Structural Racism

Introduction

While the increased burden of COVID-19 among the Black population has been recognized, most attempts to quantify the extent of this racial disparity have not taken the age distribution of the population into account. In this paper, we determine the Black–White disparity in COVID-19 mortality rates across 35 states using direct age standardization. We then explore the relationship between structural racism and differences in the magnitude of this disparity across states.

Methods

Using data from the Centers for Disease Control and Prevention, we calculated both crude and age-adjusted COVID-19 mortality rates for the non-Hispanic White and non-Hispanic Black populations in each state. We explored the relationship between a state-level structural racism index and the observed differences in the racial disparities in COVID-19 mortality across states. We explored the potential mediating effects of disparities in exposure based on occupation, underlying medical conditions, and health care access.

Results

Relying upon crude death rate ratios resulted in a substantial underestimation of the true magnitude of the Black–White disparity in COVID-19 mortality rates. The structural racism index was a robust predictor of the observed racial disparities. Each standard deviation increase in the racism index was associated with an increase of 0.26 in the ratio of COVID-19 mortality rates among the Black compared to the White population.

Conclusions

Structural racism should be considered a root cause of the Black–White disparity in COVID-19 mortality. Dismantling the long-standing systems of racial oppression is critical to adequately address both the downstream and upstream causes of racial inequities in the disease burden of COVID-19.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40615-021-01028-1.

Elevated COVID19 mortality risk in detroit area hospitals among patients from census tracts with extreme socioeconomic vulnerability

BACKGROUND

the incidence of novel coronavirus disease (COVID19) is elevated in areas with heightened socioeconomic vulnerability. Early reports from US hospitals also implicated social disadvantage and chronic disease history as COVID19 mortality risk factors. However, the relationship between race and COVID19 mortality remains unclear.

METHODS

we examined in-hospital COVID19 mortality risk factors in a multi-hospital tertiary health care system that serves greater Detroit, Michigan, a predominantly African American city with high rates of poverty and chronic disease. Consecutive adult patients who presented to emergency departments and tested positive for COVID19 from 3/11/2020 through 4/18/2020 were included. Using log-binomial regression, we assessed the relationship between in-hospital mortality and residence in census tracts that were flagged for extreme socioeconomic vulnerability, patient-level demographics, and clinical comorbidities.

FINDINGS

a total of 1,015 adults tested positive for COVID19 during the study period; 80% identified as Black people, 52% were male and 53% were ≥ 65 years of age. The median body mass index was 30•4 and the median Charlson Comorbidity Index score was 4. Patients from census tracts that were flagged for vulnerability related to socioeconomic status had a higher mortality rate than their peers who resided in less vulnerable census tracts (β 0.26, standard error (SE) 0.11, degrees of freedom (df) 378, t-value (t) 2.27, exp(β) 1.29, p-value 0.02). Adjustment for age category, Black race, sex and/or the Charlson Comorbidity Index score category reduced the magnitude of association by less than 10% [exp(β) 1.29 vs. 1.21]. Black race [p = 0.38] and sex [p = 0.62] were not associated with mortality in this sample.

INTERPRETATION

people who lived in areas flagged for extreme socioeconomic vulnerability had elevated mortality risk in our predominantly African-American cohort of COVID19 patients who were able to seek hospital care during the so-called 'first wave' of the pandemic. By contrast, Black race was not associated with mortality in our sample.