Original Article

Neighborhood Ecologies, Cases, and Deaths during the Beginning of the COVID-19 Pandemic: Lessons for Current and Future Epidemics?

Authors: Peter T. Baltrus, PhD, Chaohua Li, MPH, Megan Douglas, JD, Robina Josiah Willock, PhD, Ashley Daniel, MS, Dominic Mack, MD, MBA, Anne H. Gaglioti, MD, MS

Abstract

Objectives: The coronavirus disease 2019 (COVID-19) pandemic has disproportionately affected Black and Latinx communities. Ecologic analyses have shown that counties with a higher percentage of Latinx and Black people have worse COVID-19 outcome rates. Few ecologic analyses have been published at the neighborhood (census tract) level. We sought to determine whether certain sociodemographic neighborhood ecologies were associated with COVID-19 case and death rates in metropolitan Atlanta, Georgia.

Methods: We used census data and principal-component analysis to identify unique neighborhood ecologies. We then estimated correlation coefficients to determine whether the neighborhood profiles produced by a principal-component analysis were correlated with COVID-19 case and death rates. We conducted geographically weighted regression models to assess how correlation coefficients varied spatially for neighborhood ecologies and COVID-19 outcomes.

Results: We identified two unique neighborhood profiles: (1) high percentage of residents, Hispanic ethnicity, without a high school diploma, without health insurance, living in crowded households, and lower percentage older than 65 years; and (2) high percentage of residents, Black race, living in poverty, unemployed, and households receiving Supplemental Nutrition Assistance Program benefits. Profile 1 was associated with COVID-19 case rate (Pearson r = 0.462, P < 0.001) and profile 2 was associated with COVID-19 death rate (Spearman r = 0.279, P < 0.001). Correlations between neighborhood profiles and COVID-19 outcomes varied spatially.

Conclusions: Neighborhoods were differentially at risk of COVID-19 cases or deaths depending on their sociodemographic ecology at the beginning of the COVID-19 pandemic. Prevention methods and interventions may need to consider different social determinants of health when addressing potential cases and deaths during future emergent epidemics.
Posted in: Infectious Disease146

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References

1. Mackey K, Ayers CK, Kondo KK, et al. Racial and ethnic disparities in COVID-19-related infections, hospitalizations, and deaths: a systematic review. AnnInternMed2021;174: 362–373.
 
2. Garg S, Kim L, Whitaker M, et al. Hospitalization rates and characteristics of patients hospitalized with laboratory-confirmed coronavirus disease 2019– COVID-NET, 14 states, March 1-30, 2020. MMWR Morb Mortal Wkly Rep 2020;69:458–464.
 
3. Gaglioti AH, Li C, Douglas MD, et al. Population-level disparities in COVID-19: measuring the independent association of the proportion of Black population on COVID-19 cases and deaths in US counties. J Public Health Manag Pract 2021;27:268–277.
 
4. Millett GA, Jones AT, Benkeser D, et al. Assessing differential impacts of COVID-19 on Black communities. Ann Epidemiol 2020;47:37–44.
 
5. Turner DP, Deng H. A conceptual introduction to regression. Headache 2020;60:1047–1055.
 
6. Baltrus PT, Douglas M, Li C,etal. Percentage of Black population and primary care shortage areas associated with higher COVID-19 case and death rates in Georgia counties. South Med J 2021;114:57–62.
 
7. Sainani KL. Introduction to principal components analysis. PM R 2014;6:275–278.
 
8. Kiaghadi A, Rifai HS, Liaw W. Assessing COVID-19 risk, vulnerability and infection prevalence in communities. PLoS One 2020;15:e0241166.
 
9. Rizaldi AA, Xie S, Hubbard RA, et al. Neighborhood characteristics and COVID-19 incidence and mortality in southeastern Pennsylvania. AMIA Jt Summits Transl Sci Proc 2022;2022:422–431.
 
10. Flanagan BE, Gregory EW, Hallisey EJ, et al. A social vulnerability index for disaster management. J Homel Secur Emerg Manag 2011; 8:3.
 
11. Kind AJH, Buckingham WR. Making neighborhood-disadvantage metrics accessible—the neighborhood atlas. N Engl J Med 2018;378:2456–2458.
 
12. Alsan M, Stanford FC, Banerjee A, et al. Comparison of knowledge and information-seeking behavior after general COVID-19 public health messages and messages tailored for Black and Latinx communities: a randomized controlled trial. Ann Intern Med 2021;174:484–492.
 
13. Despres C, Aguilar R, McAlister A, et al. Communication for awareness and action on inequitable impacts of COVID-19 on Latinos. Health Promot Pract 2020;21:859–861.
 
14. Robinson WS. Ecological correlations and the behavior of individuals. Am Sociol Rev 1950;15:351–357.