1. Coronavirus disease 2019 (COVID-19) outcomes were shown to be worse in clusters of higher social vulnerability in three major cities in the United States.
2. Socioeconomic status, household composition, and disability were shown to be associated with worse COVID-19 outcomes.
Evidence Rating Level: 2 (Good)
Study Rundown: COVID-19 has been shown to have a disparate burden on different sub-populations in cities. This study explored the social and spatial inequities of COVID-19 in three United States cities. The study was conducted through autocorrelation of the Centers for Disease Control’s Social Vulnerability Index (SVI) with COVID-19 outcomes such as testing, infection positivity, confirmed cases, and mortality. The study found that areas of higher social vulnerability were generally associated with worse COVID-19 outcomes. This study’s strengths lie in a quantification of the differential burden of the pandemic within major cities, using data from a sizeable time-period, and usage of a robust and comprehensive metric in SVI as a predictor. However, this study was limited by the inability to capture individual-level data and within-neighborhood sociodemographic heterogeneity. Nonetheless, the study’s results are significant by demonstrating that areas of higher social vulnerability have been more adversely affected by the pandemic than areas with lower social vulnerability.
In-Depth [cross-sectional study]: The ecological study used 281 ZIP codes in Chicago, New York City, and Philadelphia from March to September 2020. The ZIP codes were used to map the ZIP code tabulation area (ZCTA). The ZCTAs which were not part of each city were excluded from the study. The primary outcomes were the total number of tests, positivity ratio, confirmed cases, and mortality rate. The global Moran I statistic was used to find a correlation in the distribution of these factors. Testing, positivity, confirmed cases, and mortality was correlated in geographic clusters, and these clusters corresponded to areas of higher social vulnerability (global Moran I, 0.198 to 0.803, P < 0.001 in all cases except confirmed cases in Philadelphia, with P = 0.011). Areas such as the South and West sides of Chicago, the Bronx and Queens in New York City, and North and Northeast Philadelphia had high positivity rates. Furthermore, one standard deviation higher value of the SVI index in Chicago, New York, and Philadelphia was associated with higher positivity (40%, 37%, and 40% respectively), higher confirmed cases (22%, 33%, and 27% respectively) and higher mortality (44%, 56%, and 58% respectively). Furthermore, socioeconomic status, household composition, and disability similarly correlated with outcomes; however, weaker associations with COVID-19 outcomes were found for housing type and transportation domain. Overall, the study identified disparities in COVID-19 outcomes in more socially vulnerable areas of Chicago, New York, and Philadelphia.
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