Spatial Inequities in COVID-19 Testing, Positivity, Confirmed Cases, and Mortality in 3 US Cities An Ecological Study
Spatial Inequities in COVID-19 Testing, Positivity, Confirmed Cases, and Mortality in 3 US Cities An Ecological Study
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DOI：
10.7326/m20-3936
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发表时间：
2021-07-01
影响因子：
39.2
通讯作者：
Roux, Ana V. Diez
中科院分区：
文献类型：
--
作者：
Bilal, Usama;Tabb, Loni P.;Roux, Ana V. Diez
背景资料：初步证据显示2019年冠状病毒病的不公平性目的：探讨在大流行的前6个月内，纽约、费城和芝加哥的COVID-19检测、阳性、确诊病例和死亡率出现的空间不平等。设计：2020年3月至9月在邮政编码列表区（ZCTA）水平进行的生态观察性研究。设置：芝加哥，纽约和费城。参与者：3个城市中所有居住的ZCTA。测量：结果为截至2020年9月底的ZCTA水平COVID-19检测、阳性、确诊病例和累计死亡率。预测因素是从2014-2018年美国社区调查中获得的疾病控制和预防中心社会脆弱性指数及其4个领域。使用全球和本地Moran I统计量检查COVID-19结果的空间自相关性，并使用空间条件自回归负二项模型检查估计关联。结果：发现高和低阳性率、确诊病例和死亡率的空间集群，与3个城市的低和高社会脆弱性集群位于同一地点。还发现了在检测、阳性、确诊病例和死亡率方面存在空间不平等的证据。具体来说，社区具有较高的社会脆弱性有较低的检测率和较高的阳性率，确诊率，和mortality rates.Limitations：ZCTA是不完善的和异质性的地理分析单位。结论：美国3个大城市在COVID-19检测、阳性、确诊病例和死亡率方面存在空间不平等。
Background: Preliminary evidence has shown inequities in coronavirus disease 2019 (COVID-19)-related cases and deaths in the United States.Objective: 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.Design: Ecological, observational study at the ZIP code tabulation area (ZCTA) level from March to September 2020.Setting: Chicago, New York, and Philadelphia.Participants: All populated ZCTAs in the 3 cities.Measurements: 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.Results: 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.Limitations: The ZCTAs are imperfect and heterogeneous geographic units of analysis. Surveillance data were used, which may be incomplete.Conclusion: Spatial inequities exist in COVID-19 testing, positivity, confirmed cases, and mortality in 3 large U.S. cities.