Spatial Inequities in COVID-19 Testing, Positivity, Confirmed Cases, and Mortality in 3 U.S. Cities
Usama Bilal, Loni Philip Tabb, Sharrelle Barber, Ana V. Diez Roux
Abstract
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: 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. PRIMARY FUNDING SOURCE: National Institutes of Health.