The Environmental and Social Determinants of Health Matter in a Pandemic: Predictors of COVID-19 Case and Death Rates in New York City

Social determinants of health disparities in Staten Island compared with Manhattan, Queens, Brooklyn, and the Bronx: Contribution to COVID-19 outcomes

INTRODUCTION

Social determinants of health (SDH) negatively affected Coronavirus disease-2019 (COVID-19) outcomes within the five boroughs of New York City. The goal of this study was to determine whether differences in social demographics within the borough of Staten Island, compared with the other four boroughs, may have contributed to poor COVID-19 outcomes in Staten Island.

METHODS

Data were obtained from public data sources. Social demographics obtained included age, household income, poverty status, and education level. COVID-19 infection, hospitalization, and death rates reported from Staten Island were compared with rates from Manhattan, Queens, Brooklyn, and the Bronx (February 29, 2020-October 31, 2022). Mean differences in case rates of COVID-19 were higher in Staten Island compared to all four boroughs.

RESULTS

Mean differences in hospitalization and death rates were higher than Manhattan but similar to the other four boroughs. Within Staten Island, case rates were highest in zip codes 10306 and 10309. Hospitalization and death rates were highest in Staten Island zip code 10304. We found that the zip codes of Staten Island with poorer COVID-19 outcomes had more individuals with less than a high school degree, lower mean household income, higher proportion of households earning less than $25,000 a year, and a greater proportion of individuals using public transportation.

CONCLUSION

Differences in COVID-19 infection, hospitalization, and death rates exist between the five boroughs and between the 12 zip codes within Staten Island. These differences in COVID-19 outcomes can be attributed to different SDH.

Social Determinants of Health and COVID-19

The coronavirus disease 2019 (COVID-19) pandemic has disproportionately affected disadvantaged populations. Many of the factors related to the disproportionate impact on underserved communities are related to social determinants of health, defined by the World Health Organization as the nonmedical factors that influence health outcomes. They include the wider set of forces and systems shaping the conditions of daily life. This work explores the interrelationships between social determinants of health and access to care, health care professional and supply shortages, social and environmental factors, health behaviors, vaccine uptake, and treatment options on COVID-19 health outcomes. Increased awareness of inequities, learning from failures, and leveraging new opportunities to partner with key stakeholders in underserved communities create empowerment and preparedness to face new challenges.

Comparison of Current Attitudes Toward COVID-19 Vaccination in New York City and the US Nationally

COVID-19 vaccination has resulted in decreased hospitalization and mortality, particularly among those who have received a booster. As new effective pharmaceutical treatments are now available and requirements for non-pharmaceutical interventions (e.g. masking) are relaxed, perceptions of the risk and health consequences of SARS-CoV-2 infection have decreased, risking potential resurgence. This June 2022 cross-sectional comparative study of representative samples in New York City (NYC, n = 2500) and the United States (US, n = 1000) aimed to assess differences in reported vaccine acceptance as well as attitudes toward vaccination mandates and new COVID-19 information and treatments. NYC respondents reported higher COVID-19 vaccine acceptance and support for vaccine mandate than U.S. respondents, yet lower acceptance for the booster dose. Nearly one-third of both NYC and U.S. respondents reported paying less attention to COVID-19 vaccine information than a year earlier, suggesting health communicators may need innovation and creativity to reach those with waning attention to COVID-19-related information.

COVID-19 mortality and deprivation: pandemic, syndemic, and endemic health inequalities

COVID-19 has exacerbated endemic health inequalities resulting in a syndemic pandemic of higher mortality and morbidity rates among the most socially disadvantaged. We did a scoping review to identify and synthesise published evidence on geographical inequalities in COVID-19 mortality rates globally. We included peer-reviewed studies, from any country, written in English that showed any area-level (eg, neighbourhood, town, city, municipality, or region) inequalities in mortality by socioeconomic deprivation (ie, measured via indices of multiple deprivation: the percentage of people living in poverty or proxy factors including the Gini coefficient, employment rates, or housing tenure). 95 papers from five WHO global regions were included in the final synthesis. A large majority of the studies (n=86) found that COVID-19 mortality rates were higher in areas of socioeconomic disadvantage than in affluent areas. The subsequent discussion reflects on how the unequal nature of the pandemic has resulted from a syndemic of COVID-19 and endemic inequalities in chronic disease burden.

Coronavirus disease 2019 (COVID-19) in assisted living communities: Neighborhood deprivation and state social distancing policies matter

BACKGROUND

Residents of long-term care facilities face significantly greater risk of contracting or dying from coronavirus disease 2019 (COVID-19). However, little is known about COVID-19 in assisted living communities (ALCs) and the potential determinants of its spread. We examined the association between COVID-19 cases in ALCs and the proportion of Medicare-Medicaid (dual) eligible minority residents, neighborhood area deprivation, and state COVID-19 policy stringency.

METHODS

We conducted longitudinal analyses employing data on confirmed COVID-19 cases in ALCs in 5 states. We sought to determine the weekly cumulative number of COVID-19 cases in ALCs. Covariates were ALC characteristics, area deprivation index, and state COVID-19 policy stringency. Multivariate 2-part models were used to determine the associations between independent variables and the likelihood of an outbreak and the overall count of cases.

RESULTS

In our study sample, 201 ALCs (7.04%) reported 1 or more COVID-19 cases as of August 17, 2020. A higher percentage of minority residents was associated with an increased likelihood of an ALC reporting at least 1 COVID-19 case (odds ratio [OR], 1.06; P = .032). Conditional on having at least 1 case, ALCs in states with stricter social distancing policies had lower case counts (incidence rate ratio [IRR], 0.98; P < .001). Greater neighborhood deprivation was associated with higher case count (IRR, 1.36; P = .049).

CONCLUSIONS

ALCs with higher proportions of dual-eligible minority residents were more likely to have COVID-19 outbreaks within their communities. ALCs located in more socioeconomically deprived neighborhoods, and in states with less stringent state social distancing policies, tended to have more COVID-19 cases.