The Health Consequences of Urban Scaling

项目摘要 COVID-19大流行在美国造成超过10万人死亡，在那里，COVID-19的不平等现象非常普遍， 报告了19项针对少数种族/族裔（包括西班牙裔）的结果。西班牙裔遭受特定的 导致感染风险增加的社会脆弱性，以及流行率增加的具体风险因素， 导致严重疾病风险增加。不过，拉美裔的确诊病例数量可能严重 由于地区和人口群体的检测覆盖率不同，因此被低估。此外，大多数初步 对死亡率不平等的衡量忽视了种族/族裔群体不同年龄结构的作用。 因此，对COVID-19结果中的种族/民族不平等进行一致的估计是探索 这些不平等的趋势和预测因素，作为改进未来干预措施针对性的第一步。 与此同时，已经部署了几种非药物干预措施来控制这一流行病， 少数种族/族裔坚持或受益于新政策的能力受到若干结构性因素的限制， 障碍，包括社会安全网不足，远程工作的可能性较低， 重要职业。总的来说，这些结构性限制使隔离更具挑战性，并增加了 即使在社交距离较远的地区，也有可能受到感染。持续的病毒传播， 人口亚群使得对整个人口的大流行病控制更具挑战性， 更有可能出现未来的浪潮。总之，西班牙裔是受影响最大的种族/族裔群体之一， 同时也是最不能从NPI中受益的群体之一。当前和今后一 在大流行的浪潮中，必须减少整个人口的感染风险，以减少社区 传输;因此。因此，了解卫生不公平现象在哪里以及为什么会更普遍， 跨不同群体的工作是通过减少社区总体水平来防止未来浪潮的关键 传输我们建议系统地研究卫生不公平异质性的趋势和预测因素 西班牙裔和非西班牙裔白人（NHW）之间以及社区之间的COVID-19结果 他们主要居住在美国城市之间和城市内部，以及西班牙裔美国人的NPI潜在的不平等影响 vs NHW.我们将利用来自30个最大城市的按种族/民族和社区划分的COVID-19结果数据 美国的城市，纠正不完善的测试质量和覆盖面;（2）社会不平等的措施;（3） 州、县和市各级政策的各种汇编。通过使用不同类型的城市样本， 我们将揭示不平等现象和这些不平等现象的预测因素，以便更具体地针对 这些干预措施可能是继续控制当前流行病浪潮和防止未来 波我们还将证明NPI是否可能在西班牙裔或以西班牙裔为主的人群中效果较差 邻里关系由于NPI仍然是流行病控制的最有效工具， 亚组对整个群体都有危害。 德崇内部数据

PROJECT SUMMARY The COVID-19 pandemic has killed more than 100,000 people in the US, where very wide inequities in COVID- 19 outcomes have been reported for racial/ethnic minorities, including Hispanics. Hispanics suffer from specific social vulnerabilities that lead to increased risk of infection, and increased prevalence specific risk factors that lead to increased risk of severe illness. However, the number of confirmed cases in Hispanics may be severely underestimated due to differential coverage of testing by area and population group. Moreover, most preliminary measures of inequities in mortality have ignored the role of the different age structure of racial/ethnic groups. Creating consistent estimates of racial/ethnic inequities in COVID-19 outcomes is therefore key to exploring trends and predictors of these inequities, as a first step to improve the targeting of future interventions. Concurrently, several non-pharmaceutical interventions (NPI) have been deployed to control the pandemic, The capacity of racial/ethnic minorities to adhere to or benefit from (NPI) has been limited by several structural barriers, including deficient social safety nets, a lower possibility of teleworking and a higher likelihood of working in essential occupations. Overall, these structural constraints make isolation more challenging and increase the likelihood of exposure to infection even in areas with social distancing. Continued viral transmission in specific population subgroups makes the control of the pandemic more challenging for the entire population, and the emergence of future waves more likely. In summary, Hispanics are one of the racial/ethnic groups most impacted by the pandemic and, concurrently, one of the groups least able to benefit from NPI. For the current and future waves of the pandemic, it is imperative to reduce the risk of infection across the population to reduce community transmission; therefore. Therefore, understanding where and why health inequities are wider and whether NPI work across different groups is key to preventing future waves by reducing overall levels community transmission. We propose to systematically examine trends and predictors of heterogeneities of health inequities in COVID-19 outcomes between Hispanics and non-Hispanic whites (NHW), and between the neighborhoods where they predominantly live, across and within US cities, and the potential unequal effect of NPI in Hispanics vs NHW. We will leverage data on COVID-19 outcomes by race/ethnicity and neighborhood from the 30 largest cities of the US, corrected for imperfect testing quality and coverage; (2) social inequality measures; and (3) a diverse set of compilations of state-, county- and city-level policies. By using a heterogeneous sample of cities, we will uncover inequities and predictors of these inequities that will allow for more specific targeting of interventions that may prove key in continuing to control current waves of the pandemic and to prevent future waves. We will also demonstrate whether NPI may be less effective in Hispanics or predominantly Hispanic neighborhoods. Since NPI remain the most effective tool for epidemic control, their failure on specific population subgroups represents a hazard for the entire population. Drexel Internal Data