Abstract
BackgroundPrevious studies have shown that various social determinants of health (SDOH) may have contributed to the disparities in COVID-19 incidence and mortality among minorities and underserved populations at the county or zip code level.ObjectiveThis analysis was carried out at a granular spatial resolution of census tracts to explore the spatial patterns and contextual SDOH associated with COVID-19 incidence from a Hispanic population mostly consisting of a Mexican American population living in Cameron County, Texas on the border of the United States and Mexico. We performed age-stratified analysis to identify different contributing SDOH and quantify their effects by age groups.MethodsWe included all reported COVID-19–positive cases confirmed by reverse transcription–polymerase chain reaction testing between March 18 (first case reported) and December 16, 2020, in Cameron County, Texas. Confirmed COVID-19 cases were aggregated to weekly counts by census tracts. We adopted a Bayesian spatiotemporal negative binomial model to investigate the COVID-19 incidence rate in relation to census tract demographics and SDOH obtained from the American Community Survey. Moreover, we investigated the impact of local mitigation policy on COVID-19 by creating the binary variable “shelter-in-place.” The analysis was performed on all COVID-19–confirmed cases and age-stratified subgroups.ResultsOur analysis revealed that the relative incidence risk (RR) of COVID-19 was higher among census tracts with a higher percentage of single-parent households (RR=1.016, 95% posterior credible intervals [CIs] 1.005, 1.027) and a higher percentage of the population with limited English proficiency (RR=1.015, 95% CI 1.003, 1.028). Lower RR was associated with lower income (RR=0.972, 95% CI 0.953, 0.993) and the percentage of the population younger than 18 years (RR=0.976, 95% CI 0.959, 0.993). The most significant association was related to the “shelter-in-place” variable, where the incidence risk of COVID-19 was reduced by over 50%, comparing the time periods when the policy was present versus absent (RR=0.506, 95% CI 0.454, 0.563). Moreover, age-stratified analyses identified different significant contributing factors and a varying magnitude of the “shelter-in-place” effect.ConclusionsIn our study, SDOH including social environment and local emergency measures were identified in relation to COVID-19 incidence risk at the census tract level in a highly disadvantaged population with limited health care access and a high prevalence of chronic conditions. Results from our analysis provide key knowledge to design efficient testing strategies and assist local public health departments in COVID-19 control, mitigation, and implementation of vaccine strategies.
Highlights
COVID-19, which comes from SARS-CoV-2, has caused death, health care system stress, and global economic instability
In our study, social determinants of health (SDOH) including social environment and local emergency measures were identified in relation to COVID-19 incidence risk at the census tract level in a highly disadvantaged population with limited health care access and a high prevalence of chronic conditions
Previous studies have shown various social determinants of health (SDOH) that may explain the disparity in COVID-19 incidence and mortality in ethnic and racial minorities [1,4,5]
Summary
COVID-19, which comes from SARS-CoV-2, has caused death, health care system stress, and global economic instability. In the United States, it has disproportionately affected minority and underserved populations, where COVID-19 infection and fatality rates are significantly higher among African American and Hispanic populations [1,2,3]. Previous studies have shown various social determinants of health (SDOH) that may explain the disparity in COVID-19 incidence and mortality in ethnic and racial minorities [1,4,5]. Studies that investigate the SDOH and COVID-19 incidence and mortality at a geographical scale smaller than the US county are limited [7,8]. Previous studies have shown that various social determinants of health (SDOH) may have contributed to the disparities in COVID-19 incidence and mortality among minorities and underserved populations at the county or zip code level
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