Abstract
Preliminary evidence has shown inequities in coronavirus disease 2019 (COVID-19)-related cases and deaths in the United States. To explore the emergence of spatial inequities in COVID-19 testing, positivity, confirmed cases, and mortality in New York, Philadelphia, and Chicago during the first 6 months of the pandemic. Ecological, observational study at the ZIP code tabulation area (ZCTA) level from March to September 2020. Chicago, New York, and Philadelphia. All populated ZCTAs in the 3 cities. Outcomes were ZCTA-level COVID-19 testing, positivity, confirmed cases, and mortality cumulatively through the end of September 2020. Predictors were the Centers for Disease Control and Prevention Social Vulnerability Index and its 4 domains, obtained from the 2014-2018 American Community Survey. The spatial autocorrelation of COVID-19 outcomes was examined by using global and local Moran I statistics, and estimated associations were examined by using spatial conditional autoregressive negative binomial models. Spatial clusters of high and low positivity, confirmed cases, and mortality were found, co-located with clusters of low and high social vulnerability in the 3 cities. Evidence was also found for spatial inequities in testing, positivity, confirmed cases, and mortality. Specifically, neighborhoods with higher social vulnerability had lower testing rates and higher positivity ratios, confirmed case rates, and mortality rates. The ZCTAs are imperfect and heterogeneous geographic units of analysis. Surveillance data were used, which may be incomplete. Spatial inequities exist in COVID-19 testing, positivity, confirmed cases, and mortality in 3 large U.S. cities. National Institutes of Health.
Highlights
As of the end of 2020, the COVID-19 pandemic had taken the lives of more than 1.5 people worldwide, while in the US deaths have surpassed 350,000 [1]
For example in New York City, both Blacks and Hispanics have double the age-adjusted mortality rate as compared to non-Hispanic whites[3], in Chicago 50% of deaths have occurred in Blacks, who make up only 30% of the population[4], while in Philadelphia, age-specific incidence, hospitalization, and mortality rates for Blacks and Hispanics are 2-3 times higher than for non-Hispanic whites[5]
Positivity, confirmed cases, and mortality were spatially autocorrelated in the three cities, with the exception of mortality in Philadelphia for which we did not find evidence for significant spatial autocorrelation
Summary
As of the end of 2020, the COVID-19 pandemic had taken the lives of more than 1.5 people worldwide, while in the US deaths have surpassed 350,000 [1]. For example in New York City, both Blacks and Hispanics have double the age-adjusted mortality rate as compared to non-Hispanic whites[3], in Chicago 50% of deaths have occurred in Blacks, who make up only 30% of the population[4], while in Philadelphia, age-specific incidence, hospitalization, and mortality rates for Blacks and Hispanics are 2-3 times higher than for non-Hispanic whites[5] These stark differences by race are consistent with racial health inequities in many health outcomes and likely reflect multiple interrelated processes linked to structural inequity, historical racist policies, and residential segregation[6,7,8]. Preliminary evidence has shown inequities in COVID-19 related cases and deaths in the US
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