The Providence Veterans Affairs Medical Center, Lifespan Hospitals and the Warren Alpert Medical School at Brown University, Providence, Rhode Island, United States of America.
PLoS One. 2020 Nov 2;15(11):e0241327. doi: 10.1371/journal.pone.0241327. eCollection 2020.
Poor housing conditions have been linked with worse health outcomes and infectious disease spread. Since the relationship of poor housing conditions with incidence and mortality of COVID-19 is unknown, we investigated the association between poor housing condition and COVID-19 incidence and mortality in US counties.
We conducted cross-sectional analysis of county-level data from the US Centers for Disease Control, US Census Bureau and John Hopkins Coronavirus Resource Center for 3135 US counties. The exposure of interest was percentage of households with poor housing conditions (one or greater of: overcrowding, high housing cost, incomplete kitchen facilities, or incomplete plumbing facilities). Outcomes were incidence rate ratios (IRR) and mortality rate ratios (MRR) of COVID-19 across US counties through 4/21/2020. Multilevel generalized linear modeling (with total population of each county as a denominator) was utilized to estimate relative risk of incidence and mortality related to poor housing conditions with adjustment for population density and county characteristics including demographics, income, education, prevalence of medical comorbidities, access to healthcare insurance and emergency rooms, and state-level COVID-19 test density. We report incidence rate ratios (IRRs) and mortality ratios (MRRs) for a 5% increase in prevalence in households with poor housing conditions.
Across 3135 US counties, the mean percentage of households with poor housing conditions was 14.2% (range 2.7% to 60.2%). On April 21st, the mean (SD) number of cases and deaths of COVID-19 were 255.68 (2877.03) cases and 13.90 (272.22) deaths per county, respectively. In the adjusted models standardized by county population, with each 5% increase in percent households with poor housing conditions, there was a 50% higher risk of COVID-19 incidence (IRR 1.50, 95% CI: 1.38-1.62) and a 42% higher risk of COVID-19 mortality (MRR 1.42, 95% CI: 1.25-1.61). Results remained similar using earlier timepoints (3/31/2020 and 4/10/2020).
Counties with a higher percentage of households with poor housing had higher incidence of, and mortality associated with, COVID-19. These findings suggest targeted health policies to support individuals living in poor housing conditions should be considered in further efforts to mitigate adverse outcomes associated with COVID-19.
住房条件差与健康状况恶化和传染病传播有关。由于目前尚不清楚住房条件差与 COVID-19 的发病率和死亡率之间的关系，我们调查了美国县的贫困住房条件与 COVID-19 的发病率和死亡率之间的关系。
我们对美国疾病控制中心、美国人口普查局和约翰霍普金斯冠状病毒资源中心的 3135 个美国县的县级数据进行了横断面分析。感兴趣的暴露因素是住房条件差的家庭比例（一种或多种情况：过度拥挤、住房成本高、厨房设施不完整或管道设施不完整）。结果是截至 2020 年 4 月 21 日，美国各县的 COVID-19 发病率（IRR）和死亡率（MRR）。采用多水平广义线性模型（以每个县的总人口为分母），在调整人口密度和包括人口统计学、收入、教育、医疗合并症患病率、获得医疗保健保险和急诊室的机会以及州级 COVID-19 检测密度在内的县特征后，估计与贫困住房条件相关的发病率和死亡率的相对风险。我们报告了家庭住房条件较差的家庭比例每增加 5%，发病率（IRR）和死亡率（MRR）的情况。
在 3135 个美国县中，住房条件差的家庭比例平均为 14.2%（范围为 2.7%至 60.2%）。4 月 21 日，每个县的 COVID-19 平均（SD）病例数和死亡数分别为 255.68（2877.03）例和 13.90（272.22）例。在按县人口标准化的调整模型中，家庭住房条件较差的比例每增加 5%，COVID-19 的发病率风险就会增加 50%（IRR 1.50，95%CI：1.38-1.62），COVID-19 的死亡率风险就会增加 42%（MRR 1.42，95%CI：1.25-1.61）。使用较早的时间点（2020 年 3 月 31 日和 4 月 10 日），结果仍然相似。
家庭住房条件较差的县 COVID-19 的发病率和死亡率较高。这些发现表明，在进一步努力减轻 COVID-19 相关不良后果时，应考虑针对居住在贫困住房条件下的个人制定有针对性的卫生政策。
