Beyond the 405 and the 5: Geographic Variations and Factors Associated With Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Positivity Rates in Los Angeles County.

Abstract

ObjectivesTo highlight geographic differences and the socio-structural determinants of SARS-CoV-2 test positivity within Los Angeles County (LAC).MethodsA geographic information system was used to integrate, map, and analyze SARS-CoV-2 testing data reported by LAC DPH, and data from the American Community Survey. Structural determinants included race/ethnicity, poverty, insurance status, education, population and household density. We examined which factors were associated with positivity rates, using a 5% test positivity threshold, with spatial analysis and spatial regression.ResultsBetween 1 March and 30 June 2020 there were 843,440 SARS-CoV-2 tests and 86,383 diagnoses reported, for an overall positivity rate of 10.2% within the study area. Communities with high proportions of Latino/a residents, those living below the federal poverty line and with high household densities had higher crude positivity rates. Age- adjusted diagnosis rates were significantly associated with the proportion of Latino/as, individuals living below the poverty line, population, and household density.ConclusionsThere are significant local variations in test positivity within LAC and several socio-structural determinants contribute to ongoing disparities. Public health interventions, beyond shelter in place, are needed to address and target such disparities.