Do D Phuong, Frank Reanne
Public Health Policy & Administration, Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
Department of Sociology, Ohio State University, Columbus, Ohio, USA.
J Epidemiol Community Health. 2020 Oct 29. doi: 10.1136/jech-2020-215280.
The disproportionate burden of the COVID-19 pandemic on racial/ethnic minority communities has revealed glaring inequities. However, multivariate empirical studies investigating its determinants are still limited. We document variation in COVID-19 case and death rates across different racial/ethnic neighbourhoods in New York City (NYC), the initial epicentre of the U.S. coronavirus outbreak, and conduct a multivariate ecological analysis investigating how various neighbourhood characteristics might explain any observed disparities.
Using ZIP-code-level COVID-19 case and death data from the NYC Department of Health, demographic and socioeconomic data from the American Community Survey and health data from the Centers for Disease Control's 500 Cities Project, we estimated a series of negative binomial regression models to assess the relationship between neighbourhood racial/ethnic composition (majority non-Hispanic White, majority Black, majority Hispanic and Other-type), neighbourhood poverty, affluence, proportion of essential workers, proportion with pre-existing health conditions and neighbourhood COVID-19 case and death rates.
COVID-19 case and death rates for majority Black, Hispanic and Other-type minority communities are between 24% and 110% higher than those in majority White communities. Elevated case rates are completely accounted for by the larger presence of essential workers in minority communities but excess deaths in Black neighbourhoods remain unexplained in the final model.
The unequal COVID-19 case burden borne by NYC's minority communities is closely tied to their representation among the ranks of essential workers. Higher levels of pre-existing health conditions are not a sufficient explanation for the elevated mortality burden observed in Black communities.
2019年冠状病毒病（COVID-19）疫情对少数族裔社区造成的负担过重，凸显了明显的不平等现象。然而，调查其决定因素的多变量实证研究仍然有限。我们记录了美国冠状病毒爆发的最初震中纽约市（NYC）不同种族/族裔社区的COVID-19病例和死亡率差异，并进行了多变量生态分析，以研究各种社区特征如何解释任何观察到的差异。
利用纽约市卫生部邮政编码级别的COVID-19病例和死亡数据、美国社区调查的人口和社会经济数据以及疾病控制中心500个城市项目的健康数据，我们估计了一系列负二项回归模型，以评估社区种族/族裔构成（多数为非西班牙裔白人、多数为黑人、多数为西班牙裔和其他类型）、社区贫困、富裕程度、一线工作者比例、已有健康状况的比例与社区COVID-病例和死亡率之间的关系。
多数为黑人、西班牙裔和其他类型的少数族裔社区的COVID-19病例和死亡率比多数为白人的社区高出24%至110%。少数族裔社区一线工作者的大量存在完全解释了病例率的上升，但最终模型中黑人社区的超额死亡仍无法解释。
纽约市少数族裔社区所承受的不平等的COVID-19病例负担与他们在一线工作者中的占比密切相关。已有健康状况水平较高并不能充分解释黑人社区观察到的死亡率上升负担。
