Ethnic Minority Residents Research Articles

Can China’s belt and road initiative narrow the income gap between the Han people and ethnic minority residents? Evidence from a regression discontinuity design

The Belt and Road (B&R) policy is a region-oriented economic policy implemented by the Chinese government since 2010, involving the largest population and covering the largest area in the world. Whether it can significantly narrow the income gap between Han and ethnic minority residents has not been investigated in the literature. To avoid endogenous problems in the model, we used the spatial breakpoint regression method to investigate 2,037 county-level administrative regions in China from 2014 to 2021 and empirically evaluated the impact of the policy on the income gap between Han and ethnic minority residents. Results show that, compared to the counties without B&R policy, the average income gap between minority counties with B&R and Han has increased by 1.468–1.518 times, which was nearly 1.3 times the sample mean of survey data, indicating that the income gap has been widened significantly by B&R. However, the policy has a narrowing effect on the income gap between minorities and Han in the 20% sample with the widest income gap between minorities and Han. From the dynamic effect of years, with the effect of B&R, the income gap between minorities and Han is an inverted U-shaped curve, first increasing and then decreasing.

Social and Environmental Determinants of Health and Cardio-Kidney-Metabolic Syndrome–Related Mortality

It is not well understood if and how various social and environmental determinants of health (SEDoH) are associated with mortality rates related to cardio-kidney-metabolic syndrome (CKM) across the US. To study the magnitude of the association strength of SEDoH with CKM-related mortality at the county level across the US. This cross-sectional, retrospective, population-based study used aggregate county-level data from the US Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (WONDER) data portal from 2010-2019. Data analysis occurred from September 2023 to January 2024. A total of 7 diverse SEDoH were chosen, including median annual household income, percentage of racial and ethnic minority residents per county, fine particulate air pollution (PM2.5) concentrations, high-school completion rate, primary health care access, food insecurity, and rurality rate. The primary outcome was county-level age-adjusted mortality rate (aaMR) attributable to CKM. The association of county-level CKM-related aaMR with the 7 SEDoH was analyzed using geographically weighted models and the model median coefficients for each covariate studied. Data from 3101 of 3243 counties (95.6%) were analyzed. There was substantial variation in SEDoH between states and counties. The overall pooled median (IQR) aaMR (2010-2019) in the US was 505.5 (441.3-578.9) per 100 000 residents. Most counties in the lower half of the US had rates much higher than the pooled median (eg, Southern US median [IQR] aaMR, 537.3 [466.0-615.9] per 100 000 residents). CKM-related mortality was positively associated with the food insecurity rate (median [IQR] β = 6.78 [2.78-11.56]) and PM2.5 concentrations (median [IQR] β = 5.52 [-11.06 to 19.70]), while it was negatively associated with median annual household income (median [IQR] β = -0.002 [-0.003 to -0.001]), rurality (median [IQR] β = -0.32 [-0.67 to 0.02]), high school completion rate (median [IQR] β = -1.89 [-4.54 to 0.10]), racial and ethnic minority rate (median [IQR] β = -0.66 [-1.85 to 0.89]), and primary health care access rate (median [IQR] β = -0.18 [-0.35 to 0.07]). In this cross-sectional study of county-level data across the US, there were substantial geographical differences in the magnitude of the association of SEDoH with CKM-related aaMR. These findings may provide guidance for deciding local health care policy.

California’s zero-emission vehicle adoption brings air quality benefits yet equity gaps persist

Zero-emission vehicle (ZEV) adoption is a key climate mitigation tool, but its environmental justice implications remain unclear. Here, we quantify ZEV adoption at the census tract level in California from 2015 to 2020 and project it to 2035 when all new passenger vehicles sold are expected to be ZEVs. We then apply an integrated traffic model together with a dispersion model to simulate air quality changes near roads in the Greater Los Angeles. We found that per capita ZEV ownership in non-disadvantaged communities (non-DACs) as defined by the state of California is 3.8 times of that in DACs. Racial and ethnic minorities owned fewer ZEVs regardless of DAC designation. While DAC residents receive 40% more pollutant reduction than non-DACs due to intercommunity ZEV trips in 2020, they remain disproportionately exposed to higher levels of traffic-related air pollution. With more ZEVs in 2035, the exposure disparity narrows. However, to further reduce disparities, the focus must include trucks, emphasizing the need for targeted ZEV policies that address persistent pollution burdens among DAC and racial and ethnic minority residents.

Beyond Residence: A Mobility-based Approach for Improved Evaluation of Human Exposure to Environmental Hazards.

Standard environmental hazard exposure assessment methods have been primarily based on residential places, neglecting individuals' hazard exposures due to activities outside home neighborhood and underestimating peoples' overall hazard exposures. To address this limitation, this study proposes a novel mobility-based index for the hazard exposure evaluation. Using large-scale human mobility data, we quantify the extent of population dwell time in high environmental hazard places in 239 US counties for three environmental hazards. We explore how human mobility extends the reach of environmental hazards and leads to the emergence of latent exposure for populations living outside high-hazard areas. Notably, neglect of mobility can lead to over 10% underestimation of hazard exposures. The interplay of spatial clustering in high-hazard regions and human movement trends creates "environmental hazard traps." Poor and ethnic minority residents disproportionately face multiple types of environmental hazards. This data-driven evidence supports the severity of these injustices. We also studied latent exposure arising from visits outside residents' home areas, revealing millions of the population having 5 to 10% of daily activities occur in high-exposure zones. Despite living in perceived safe areas, human mobility could expose millions of residents to different hazards. These findings provide crucial insights for targeted policies to mitigate these severe environmental injustices.

Retraction Note: Health-related quality of life among ethnic minority residents in remote Western China: a cross-sectional study

This article has been retracted. Please see the Retraction Notice for more detail: https://doi.org/10.1186/s12889-023-16559-x.

The economic impact of the COVID-19 pandemic on ethnic minorities in Manchester: lessons from the early stage of the pandemic.

This review summarizes the economic impacts of the pandemic on ethnic minorities, focusing on the city of Manchester. It utilizes multiple reporting sources to explore various dimensions of the economic shock in the UK, linking this to studies of pre-COVID-19 economic and ethnic composition in Manchester and in the combined authority area of Greater Manchester. We then make inferences about the pandemic's short-term impact specific to the city region. Greater Manchester has seen some of the highest rates of COVID-19 and as a result faced particularly stringent "lockdown" regulations. Manchester is the sixth most deprived Local Authority in England, according to 2019 English Indices of Multiple Deprivation. As a consequence, many neighborhoods in the city were always going to be less resilient to the economic shock caused by the pandemic compared with other, less-deprived, areas. Particular challenges for Manchester include the high rates of poor health, low-paid work, low qualifications, poor housing conditions and overcrowding. Ethnic minority groups also faced disparities long before the onset of the pandemic. Within the UK, ethnic minorities were found to be most disadvantaged in terms of employment and housing-particularly in large urban areas containing traditional settlement areas for ethnic minorities. Further, all Black, Asian, and Minority ethnic (BAME) groups in Greater Manchester were less likely to be employed pre-pandemic compared with White people. For example, people of Pakistani and Bangladeshi ethnic backgrounds, especially women, have the lowest levels of employment in Greater Manchester. Finally, unprecedented cuts to public spending as a result of austerity have also disproportionately affected women of an ethnic minority background alongside disabled people, the young and those with no or low-level qualifications. This environment has created and sustained a multiplicative disadvantage for Manchester's ethnic minority residents through the course of the COVID-19 pandemic.

RETRACTED ARTICLE: Health-related quality of life among ethnic minority residents in remote Western China: a cross-sectional study

BackgroundPaying attention to the health-related quality of life (HRQOL) of rural residents in poverty-stricken areas is an important part of China's poverty alleviation, but most studies on health-related quality of life have focused on rural residents, elderly individuals, and patients; evidence on the HRQOL of rural minority residents is limited. Thus, this study aimed to assess the HRQOL of rural Uighur residents in remote areas of Xinjiang, China, and determine its influencing factors to provide policy opinions for realizing a healthy China strategy.MethodsA cross-sectional study was performed on 1019 Uighur residents in rural areas. The EQ-5D and self-administered questionnaires were used to assess HRQOL. We applied Tobit and binary logit regression models to analyse the factors influencing HRQOL among rural Uighur residents.ResultsThe health utility index of the 1019 residents was − 0.197,1. The highest proportion of respondents reporting any problem was for mobility (57.5%), followed by usual activity (52.8%). Low levels of the five dimensions were related to age, smoking, sleep time, Daily intake of vegetables and fruit per capita. Gender, age, marital status, physical exercise, sleep duration, daily intake of cooking oil per capita, daily intake of fruit per capita, distance to the nearest medical institution, non-infectious chronic diseases (NCDs), self-rated health score, and participation in community activities were correlated with the health utility index of rural Uighur residents.ConclusionsHRQOL was lower for rural Uyghur residents than for the general population. Improving health behavioural lifestyles and reducing the incidence of poverty (return to poverty) due to illness are effective means of promoting the health in Uyghur residents. The region must fulfil the health poverty alleviation policy and focus on vulnerable groups and low-income residents to improve the health, ability, opportunity, and confidence of this population to live well.

Theorizing COVID-19 information retrieving from a culture-centered lens: Communication infrastructures for challenging disinformation

ABSTRACT Underpinned by the notion that communication equality is crucial in developing communication infrastructures for health and well-being, this study explores experiences of COVID-19 information retrieving in a low-income suburban area in Aotearoa from a culture-centered lens. Drawing from in-depth interviews with ethnic minority residents, we reveal two polarizing experiences: at one end, residents were confident in the government’s representation of COVID-19 but also fearful and anxious, while at the other end, residents were skeptical of formal institutions and expressed alternative views about COVID-19. The findings illuminate how community distrust is intertwined with communication inequality, which can further entrench and magnify health inequality, informing key recommendations for culturally centering pandemic communications and creating infrastructures to challenge disinformation.

ACHIEVING EQUITABLE QUALITY OF CARE FOR NURSING HOME RESIDENTS

Abstract Inequities in care delivery within nursing homes are pervasive across the United States. Racial and ethnic minority residents disproportionately reside in nursing homes of poorer quality, lower staffing, and fewer resources when compared to their White counterparts. Dr. Jasmine Travers, a health services researcher at New York University and with expertise in disparities and long-term care, will present on recommendations to achieving equitable quality of care for nursing home residents.

Racial, Ethnic, and Rural/Urban Disparities in HIV and Sexually Transmitted Infections in South Carolina.

Examining the current incidence rates of HIV and STIs among racial and ethnic minority and rural residents is crucial to inform and expand initiatives and outreach efforts to address disparities and minimize the health impact of these diseases. A retrospective, cross-sectional study was conducted using Medicaid administrative claims data over a 2-year period (July 2019-June 2021) in South Carolina. Our main outcomes of interest were claims for chlamydia, gonorrhea, syphilis, and HIV. Any beneficiary with at least one claim for a relevant diagnosis throughout the study period was considered to have one of these diseases. Descriptive analyses and multivariable regression models were used to estimate the association between STIs, HIV, race and ethnicity, and rurality. Overall, 158,731 Medicaid beneficiaries had at least one medical claim during the study period. Most were female (86.6%), resided in urban areas (66.6%), and were of non-Hispanic Black race/ethnicity (42.6%). In total, 6.3% of beneficiaries had at least one encounter for chlamydia, 3.2% for gonorrhea, 0.5% for syphilis, and 0.8% for HIV. In multivariable models, chlamydia, gonorrhea, and HIV claims were significantly associated with non-Hispanic Black or other minority race/ethnicity compared to non-Hispanic white race/ethnicity. Rural residents were more likely to have a claim associated with chlamydia and gonorrhea compared to urban residents. The opposite was observed for syphilis and HIV. Providing updated evidence on disparities in STIs and HIV among racial/ethnic minority and rural populations in a southern state is essential for shaping state Medicaid policies to address health disparities.

Association of Urinary Zinc Concentrations with Dyslipidemia and Its Subtypes: Baseline Data from the Chinese Multi-Ethnic Cohort (CMEC) Study.

This study elucidates the association between urinary zinc concentration and the risk of developing dyslipidemia and its subtypes in China's ethnic minority residents. Based on the baseline survey data of the Chinese Multi-Ethnic Cohort (CMEC) study, 10,620 subjects were included in the study. Logistic regression analysis evaluated the relationship between urinary zinc concentration and dyslipidemia and its subtypes. After adjustment, compared with urinary zinc concentration quartile 1 (Q1), the odds ratios (ORs) and 95% confidence intervals (95% CIs) of dyslipidemia participants in the quartile 2 (Q2), quartile 3 (Q3), and quartile 4 (Q4) groups were 1.091 (0.963, 1.237), 1.151 (1.051, 1.304), and 1.393 (1.230, 1.579), respectively (P for trend < 0.001). While that of hypertriglyceridemia participants in the Q2, Q3, and Q4 groups were 1.130 (0.979, 1.306), 1.283 (1.113, 1.480), and 1.483 (1.287, 1.709), respectively (P for trend < 0.001). Lastly, the ORs and 95% CIs of hyperbetalipoproteinemia participants in the Q2, Q3, and Q4 groups were 1.166 (0.945, 1.439), 1.238 (1.007, 1.522), and 1.381 (1.126, 1.695), respectively (P for trend < 0.002). This study found that urinary zinc concentrations were not associated with hypercholesterolemia and hypoalphalipoproteinemia. The dose-response relationship was non-linear between urinary zinc concentration and dyslipidemia, hypertriglyceridemia and hyperbetalipoproteinemia (P for trend < 0.001). In the stratified analysis, urinary zinc levels were positively associated with the risk of dyslipidemia, hypertriglyceridemia, and hyperbetalipoproteinemia in male, ≥ 60years old, Miao nationality, hypertension, diabetes, and BMI ≥ 24.0kg/m2 subgroups. Our study provides some possible evidence that elevated urinary zinc concentrations are associated with an increased risk of dyslipidemia, hypertriglyceridemia, hyperbetalipoproteinemia.

Achieving proportional representation in a reproductive health survey through social media: process and recommendations

BackgroundThe narrative surrounding women’s reproductive health has shifted from a medical model to an emphasis on reproductive well-being over different life-stages. We developed and piloted a tracker survey for monitoring women’s reproductive health and well-being in England, recruiting respondents online. This paper reports on the success of the online recruitment strategies in achieving a sample proportionally representative of the England general population.MethodsRecruitment was through Facebook and Instagram advertisements and dissemination through Twitter and a blog. At the end week one, the sample was reviewed and compared to the 2011 Census England population. From week two, recruitment targeted under-represented groups. Key data were compared with prevalence estimates from the Third National Survey of Sexual Attitudes and Lifestyles (Natsal-3).ResultsBetween 1 July-17 August 2021, 13,962 people initiated the online survey, with 11,578 completing it. Numbers were low initially, but peaked at 1700 survey initiations per day after increasing the daily advertisement budget on day seven. At the end of week one, minority ethnic groups and people without a degree or equivalent were under-represented. From week two, we altered the advertisement settings to show to people whose profile indicated they were a ‘high school leaver’ had ‘up to some high school’, worked in industries that do not typically require a degree or lived in local authorities with a high proportion of ethnic minority residents. This had a modest effect, with the final sample short of proportional representation in terms of ethnicity and education but close in terms of region and age. Compared to Natsal-3, we found consistency in the proportion of respondents reporting an abortion and a live birth in the last year, however, the proportion of our sample reporting ever having experienced infertility was significantly higher than in Natsal-3, as was the proportion of ‘planned’ pregnancies in the last year.ConclusionsIt is possible to recruit large numbers of respondents online, relatively quickly, to complete a reproductive health survey. This will be valuable to track reproductive health and well-being at a national level over time. More work is needed to understand reasons for non-response among under-represented groups.

Absolute versus relative socioeconomic disadvantage and homicide: a spatial ecological case\u2013control study of US zip codes

BackgroundHomicide is a major cause of death and contributes to health disparities in the United States. This burden overwhelmingly affects people from racial and ethnic minority populations as homicide occurs more often in neighborhoods with high proportions of racial and ethnic minority residents. Research has identified that environmental factors contribute to variation in homicide rates between neighborhoods; however, it is not clear why some neighborhoods with high concentrations of racial and ethnic minority residents have high homicide rates while neighborhoods with similar demographic compositions do not. The aim of this study was to assess whether relative socioeconomic disadvantage, (i.e., income inequality), or absolute socioeconomic disadvantage (i.e., income) measured at the ZIP code- and state-levels, is associated with high homicide rates in US ZIP codes, independent of racial and ethnic composition.MethodsThis ecological case–control study compared median household income and income inequality in 250 ZIP codes with the highest homicide rate in our sample in 2017 (cases) to 250 ZIP codes that did not experience any homicide deaths in 2017 (controls). Cases were matched to controls 1:1 based on demographic composition. Variables were measured at both the ZIP code- and state-levels.ResultsLower median household income at the ZIP code-level contributed most substantially to the homicide rate. Income inequality at the state-level, however, was additionally significant when controlling for both ZIP code- and state-level factors.ConclusionsArea-based interventions that improve absolute measures of ZIP code socioeconomic disadvantage may reduce gaps in homicide rates.

Territorialization on tour: The tourist gaze along the Silk Road Economic Belt in Kashgar, China

Since 2009, and over the following decade, Kashgar Old City—an historical space of Uyghur culture and Islam and home to 220,000 residents—was largely demolished and rebuilt for tourists. Today, Kashgar and the Xinjiang region are major conduits into Eurasia and have become critical nodes in China’s national tourism development and Belt and Road Initiative (BRI). While scholars have addressed the geoeconomics of BRI, we know much less about how contested spaces of Chinese development are securitized. Tourism, we argue, is increasingly enrolled into the state’s broader territorialization-by-securitization strategy. The tourist gaze—or the socio-spatial mediation of touristic experience and performance—is included in this strategic arsenal. In contested areas such as Xinjiang and Tibet, the tourist gaze is spatially deployed by the state as a biopolitical mechanism that facilitates the deepening territorialization of the region and coerces ethnic minority residents to perform a sanitized revisioning of their culture, history, and religion. This article draws on interviews with Uyghur former tour guides and residents of Xinjiang, critical analysis of English and Mandarin language popular media, and observations of congruent patterns of the securitization of tourism destinations as a state-strategy of territorialization in Tibet to demonstrate how the tourist gaze is deployed as a spatial mechanism of securitization and territorialization along the Silk Road Economic Belt in Kashgar. The article contributes to emerging scholarship on the growing role of tourism in broader practices of securitization and territorialization in China and beyond.

Optimising social conditions to improve autonomy in communication and care for ethnic minority residents in nursing homes: A meta-synthesis of qualitative research.

A large proportion of nursing home residents in developed countries come from ethnic minority groups. Unmet care needs and poor quality of care for this resident population have been widely reported. This systematic review aimed to explore social conditions affecting ethnic minority residents' ability to exercise their autonomy in communication and care while in nursing homes. In total, 19 studies were included in the review. Findings revealed that ethno-specific nursing homes create the ideal social condition for residents to express their care needs and preferences in a language of choice. In nonethno-specific nursing homes, staff cultural competence and nursing home commitment to culturally safe care are crucial social conditions that enable this group of residents to fulfil their autonomy in communicating and in participating in their care. In contrast, social conditions that undermine residents' ability to express their care needs and preferences include low levels of staff cultural awareness and cultural desire, negative attitudes towards residents and limited organisational support for staff to improve culturally responsive and culturally safe care. In conclusion, it is important to optimise the social conditions to support ethnic minority residents to communicate their care needs and preferences.

Rethinking environmental justice: capability building, public knowledge and the struggle against traffic-related air pollution

For more than a decade, a broad social movement has organised significant opposition to the expansion of the Antwerp ring road. By linking the very mobile, intangible and unplaceable problem of traffic-related air pollution to the highly local, concrete, immobile issue of the highway, they succeeded in creating the largest mobilization against air pollution ever in Belgium. A distributive justice discourse which portrayed Antwerp residents as being unfairly affected has played a crucial role in this endeavour. At the same time, the movement has struggled to involve and represent those who will be most affected by the ring road extension. Low income and ethnic minority residents living close to the ring road are strikingly absent from the movements’ ranks and tend to be silenced in its discourse. In this paper, we scrutinise this disparity between the social composition of the most affected areas and the social composition of the movement dealing with the issue, and reflect on the movement’s practices of knowledge production and dissemination from an environmental justice perspective. We highlight the need for expanding environmental justice beyond a merely distributive approach and argue that environmental justice movements need to see knowledge dissemination and public pedagogy as more than just a mobilizing strategy. Without pursuing equity in the distribution of networks, capabilities and knowledge, enhancing the possibilities of those who are most affected to develop their own strategies, environmental justice is difficult to realize.

Trends in racial and ethnic disparities in coronavirus disease 2019 (COVID-19) outcomes among nursing home residents.

To evaluate trends in racial and ethnic disparities in weekly cumulative rates of coronavirus disease 2019 (COVID-19) cases and deaths in Connecticut nursing homes. Longitudinal analysis of nursing-home COVID-19 reports and other databases. Multivariable negative binomial models were used to estimate disparities in COVID-19 incidence and fatality rates across nursing-home groups with varying proportions of racial and ethnic minority residents, defined as low-, medium-, medium-high-, and high-proportion groups. Trends in such disparities were estimated from week 1 (April 13) to week 10 (ending on June 19, 2020). The study was conducted across 211 nursing homes. The average number of cases ranged from 6.1 cases per facility for the low-proportion group to 11.7 cases per facility for the high-proportion group in week 1, and from 26.7 to 58.5 cases per facility in week 10. Compared to the low-proportion group, the adjusted incidence rate ratios (IRRs) for the high-proportion group were 1.18 (95% confidence interval [CI], 0.77-1.80; P > .10) in week 1 and 1.54 (95% CI, 1.05-2.25; P < .05) in week 10, showing a 30% (95% CI, 5%-62%) relative increase (P < .05). The average weekly number of COVID-19-related deaths ranged from 0 to 0.3 deaths per facility for different groups in week 1, and from 7.6 to 13.3 deaths per facility in week 10. Adjusted disparities in fatalities similarly increased over time. Connecticut nursing homes caring for predominately racial and ethnic minority residents tended to have higher COVID-19 incidence and fatality rates. These across-facility disparities increased during the early periods of the pandemic.

Examining Racial and Ethnic Disparities Among Older Adults in Long-Term Care Facilities.

The purpose of this project was to examine individual-level ethnic and racial differences and facility-level differences in types of complaints and rates of complaint resolution in a local long-term care ombudsman program. We employed a mixed-methods sequential explanatory design. First, we analyzed secondary complaint data based on residents' race and ethnicity (n = 464) and facility characteristics (n = 101). We then conducted 2 focus groups with ombudsmen (n = 12) to provide context for our quantitative findings and to explore the ombudsmen's views on disparities in long-term care facilities. Racial and ethnic minority residents were more likely to generate complaints related to residents' rights than nonminority residents. Assisted living facilities were more likely to have complaints related to residents' rights and outside agencies than nursing homes. The rate of complaint resolution increased among facilities with a higher proportion of minority residents, compared to facilities with a lower proportion of minority residents. However, an estimation of cross-level interaction revealed that non-Hispanic White residents in these facilities experienced faster complaint resolution than minority residents. Ombudsmen expressed concerns about communication barriers between minority residents and facility staff and discussed different complaint types and resolution rates according to facility types. Our findings highlight disparities across long-term care facilities as well as disparities in care minority residents experience. Long-term care ombudsman program complaint data should be disaggregated by race and ethnicity of the residents to advocate for policy change at facility, state, and federal levels.

The Economic Impact of the COVID-19 Pandemic on Ethnic Minorities in Manchester

This rapid review summarises the economic impacts of the pandemic on ethnic minorities, focusing on the city of Manchester. It utilises multiple reporting sources to explore various dimensions of the economic shock in the UK, linking this to studies of pre-COVID-19 economic and ethnic composition in Manchester and in the combined authority area of Greater Manchester. We then make inferences about the pandemic’s impact specific to the city region. Greater Manchester has seen some of the highest rates of COVID-19 and as a result has faced particularly stringent 'lockdown' regulations. Manchester is the sixth most deprived Local Authority in England (according to 2019 English Indices of Multiple Deprivation). As a consequence, many neighbourhoods in the city were always going to be less resilient to the economic shock caused by the pandemic compared with other, less-deprived, areas. Particular challenges for Manchester include the prevalence of poor health, low-paid work, low qualifications, poor housing conditions and overcrowding. Ethnic minority groups also faced disparities long before the onset of the pandemic. Within the UK, ethnic minorities have been found to be most disadvantaged in terms of employment and housing – particularly in large urban areas containing traditional settlement areas for ethnic minorities. Further, all Black, Asian, and Minority ethnic (BAME) groups in Greater Manchester have been found to be less likely to be employed pre-pandemic compared with White people. For example, people of Pakistani and Bangladeshi ethnic backgrounds, especially women, have the lowest levels of employment in Greater Manchester. Finally, unprecedented cuts to public spending as a result of austerity have also disproportionately affected women of an ethnic minority background alongside women, disabled people, the young and those with no or low-level qualifications. This environment has created and sustained a multiplicative disadvantage for Manchester’s ethnic minority residents through the course of the COVID-19 pandemic.

Association Between Social Vulnerability and a County's Risk for Becoming a COVID-19 Hotspot - United States, June 1-July 25, 2020.

Poverty, crowded housing, and other community attributes associated with social vulnerability increase a community's risk for adverse health outcomes during and following a public health event (1). CDC uses standard criteria to identify U.S. counties with rapidly increasing coronavirus disease 2019 (COVID-19) incidence (hotspot counties) to support health departments in coordinating public health responses (2). County-level data on COVID-19 cases during June 1-July 25, 2020 and from the 2018 CDC social vulnerability index (SVI) were analyzed to examine associations between social vulnerability and hotspot detection and to describe incidence after hotspot detection. Areas with greater social vulnerabilities, particularly those related to higher representation of racial and ethnic minority residents (risk ratio [RR]=5.3; 95% confidence interval [CI]=4.4-6.4), density of housing units per structure (RR=3.1; 95% CI = 2.7-3.6), and crowded housing units (i.e., more persons than rooms) (RR=2.0; 95% CI = 1.8-2.3), were more likely to become hotspots, especially in less urban areas. Among hotspot counties, those with greater social vulnerability had higher COVID-19 incidence during the 14 days after detection (212-234 cases per 100,000 persons for highest SVI quartile versus 35-131 cases per 100,000 persons for other quartiles). Focused public health action at the federal, state, and local levels is needed not only to prevent communities with greater social vulnerability from becoming hotspots but also to decrease persistently high incidence among hotspot counties that are socially vulnerable.