Social capital and geographical variation in the incidence of COVID-19: an ecological study

Quantifying the magnitude of the general contextual effect in a multilevel study of SARS-CoV-2 infection in Ontario, Canada: application of the median rate ratio in population health research

BACKGROUND

Regional variations in SARS-CoV-2 infection were observed in Canada and other countries. Studies have used multilevel analyses to examine how a context, such as a neighbourhood, can affect the SARS-CoV-2 infection rates of the people within it. However, few multilevel studies have quantified the magnitude of the general contextual effect (GCE) in SARS-CoV-2 infection rates and assessed how it may be associated with individual- and area-level characteristics. To address this gap, we will illustrate the application of the median rate ratio (MRR) in a multilevel Poisson analysis for quantifying the GCE in SARS-CoV-2 infection rates in Ontario, Canada.

METHODS

We conducted a population-based, two-level multilevel observational study where individuals were nested into regions (i.e., forward sortation areas [FSAs]). The study population included community-dwelling adults in Ontario, Canada, between March 1, 2020, and May 1, 2021. The model included seven individual-level variables (age, sex, asthma, diabetes, hypertension, congestive heart failure, and chronic obstructive pulmonary disease) and four FSA census-based variables (household size, household income, employment, and driving to work). The MRR is a median value of the rate ratios comparing two patients with identical characteristics randomly selected from two different regions ordered by rate. We examined the attenuation of the MRR after including individual-level and FSA census-based variables to assess their role in explaining the variation in rates between regions.

RESULTS

Of the 11 789 128 Ontario adult community-dwelling residents, 343 787 had at least one SARS-CoV-2 infection during the study period. After adjusting for individual-level and FSA census-based variables, the MRR was attenuated to 1.67 (39% reduction from unadjusted MRR). The strongest FSA census-based associations were household size (RR = 1.88, 95% CI: 1.71-1.97) and driving to work (RR = 0.68, 95% CI: 0.65-0.71).

CONCLUSIONS

The individual- and area-level characteristics in our study accounted for approximately 40% of the between-region variation in SARS-CoV-2 infection rates measured by MRR in Ontario, Canada. These findings suggest that population-based policies to address social determinants of health that attenuate the MRR may reduce the observed between-region heterogeneity in SARS-CoV-2 infection rates.

Covid and the common good: In-group out-group dynamics and Covid-19 vaccination in Wales and the United States

Vaccination is a social act, where benefits spill-over to third parties. How we approach such social decisions is influenced by whether likely beneficiaries share salient social identities with us. This study explores these dynamics using representative survey data from two contexts: national identity groups in Wales (N = 4187) and political partisans in America (N = 4864). In both cases, those in the minority in their local area were less likely to be vaccinated. In Wales, respondents who did not identify as Welsh were less likely to be vaccinated the greater the proportion of residents of their local area identified as Welsh. In America, the vaccination rate of Biden voters fell off more steeply than that of Trump voters as the proportion of Trump voters in their county increased. Results are robust to controlling for likely confounds and sensitivity analyses. In-group out-group dynamics help to shape important health decisions.

Covid and the coalfield: Covid-19 vaccine hesitance in Wales and Appalachia

BACKGROUND

Vaccine hesitancy is a barrier to Covid-19 vaccine uptake and displays a social gradient, compounding health disparities. While social gradients are a vital concept in health, they flatten distinctions between types of disadvantaged community. This paper focuses on vaccine hesitance in post-industrial and de-industrialising coalfields. The social consequences of the decline of coal mining may present barriers to vaccine uptake.

METHODS

We ran parallel surveys in Wales (N = 4187) and US states overlapping with central Appalachia (N = 4864), to examine whether vaccine attitudes and uptake varied between areas with different coal mining histories. These surveys were accompanied by qualitative interviews of 36 residents of these coalfields to explore vaccination decisions and triangulate with survey data.

RESULTS

Factor analysis identified four axes of attitudes in the survey data: vaccine confidence, covid scepticism, vaccine individualism, and concerned confusion. These themes were echoed in the interviews. Vaccine confidence was lower; and covid scepticism, vaccine individualism, and concerned confusion higher, in residents of areas of Wales with greater mining extent and where pits closed during certain periods. Residents of former US coal counties had lower vaccine confidence and higher covid scepticism, while those in current coal counties had greater vaccine individualism and concerned confusion. In former US coal counties and Welsh areas where pits closed since 1980, vaccine uptake was lower. Differences could not be explained by respondents' income and education. In the interviews, norms of social solidarity were often invoked by vaccinated respondents, while unvaccinated respondents did not frame decisions in the context of the industrial history of their areas.

DISCUSSION

The legacy of coal-mining's decline presents barriers to public health campaigns. We show evidence of this across two historically significant coalfields. Attention is needed to avert negative public health consequences of global energy transition.

Mapping social capital across Wales (UK) using secondary data and spatial analysis

Social capital, a powerful community resource based on trust, relationships, norms, culture, values, networks and belonging, could shape the acceptance, cooperation, and involvement of citizens towards new policies or interventions. In past, connections of social capital have been studied in relation to human health, wellbeing, social and economic development. More recently, social capital has been studied with respect to human resilience and adaptation to climate change. We argue that social capital could also play a vital role in our efforts to reduce carbon footprint through behaviour change, a shift on shared local renewable energy resources, and adoption of low carbon technologies. In Wales (UK) there is no national scale dataset, reflecting its social capital landscape, that could be used for designing the right policies/interventions in this context, based on an expected level of trust, cooperation, and support within the communities. This paper is an effort to fill this data gap using secondary datasets. Firstly, a literature review is carried out to identify the indicators of social capital (cognitive and participatory). Secondary datasets have then been identified and acquired. Geospatial analysis has been carried out to produce the criterion maps for various indicators of social capital. Finally, Analytical Hierarchy Process is applied to generate a social capital map of Wales combining these indicators together. For validation of the produced data, social capital's known correlations were tested with crime rates, income level and multiple deprivations.

Supplementary Information

The online version contains supplementary material available at 10.1007/s43545-023-00639-1.

Association between Cooperative Attitude and High-Risk Behaviors on the Spread of COVID-19 Infection among Medical Students in Japan

The impact of high-risk behaviors on the spread of COVID-19 infection among young people is an important problem to address. This study analyzed the association between cooperativeness and high-risk behaviors. We conducted a cross-sectional study among fourth-year medical students at Tokyo Medical and Dental University. The students were asked about cooperative attitude in a hypothetical situation of performing a task together with an unfamiliar classmate, who did not cooperate to complete the task previously. The response items were as follows: "cooperate", "don't want to cooperate and do it alone (non-cooperative)", and "don't want to cooperate and let the partner do it alone (punishment)". Eating out and vaccine hesitancy were also treated as high-risk behaviors. Poisson regression was used to investigate the association between cooperative attitude and each high-risk behavior, adjusted for demographics. Of the 98 students, 23 (23.5%), 44 (44.9%), and 31 (31.6%) students chose "noncooperative", "cooperative", and "punishment", respectively. Cooperative-type students exhibited 2.77-fold (PR: 2.77, 95% CI: 1.03-7.46), and punishment-type students exhibited 3.16-fold greater risk of eating or drinking out (PR: 3.16, 95% CI: 1.14-8.75) compared with those of the noncooperative type. Among medical students, the "cooperative" type and "punishment" type comprised the high-risk group for eating out during the pandemic.