MD Anderson Cancer Center, University of Texas, Houston, TX.
Department of Health Services Research, Policy, and Practice, Brown University, Providence, RI.
Mayo Clin Proc. 2021 Jan;96(1):78-85. doi: 10.1016/j.mayocp.2020.10.019. Epub 2020 Oct 22.
To examine differences in community mobility reduction and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outcomes across counties with differing levels of socioeconomic disadvantage.
The sample included counties in the United States with at least one SARS-CoV-2 case between April 1 and May 15, 2020. Outcomes were growth in SARS-CoV-2 cases, SARS-CoV-2-related deaths, and mobility reduction across three settings: retail/recreation, grocery/pharmacy, and workplace. The main explanatory variable was the social deprivation index (SDI), a composite socioeconomic disadvantage measure.
Adjusted differences in outcomes between low-, medium-, and high-SDI counties (defined by tertile) were calculated using linear regression with state-fixed effects. Workplace mobility reduction was 1.75 (95% CI, -2.36 to -1.14; P<.001) and 3.48 percentage points (95% CI, -4.21 to -2.75; P<.001) lower for medium- and high-SDI counties relative to low-SDI counties, respectively. Mobility reductions in the other settings were also significantly lower for higher-SDI counties. In analyses adjusted for SARS-CoV-2 prevalence on April 1, medium- and high-SDI counties had 1.39 (95% CI, 0.85 to 1.93; P<.001) and 2.56 (95% CI, 1.77 to 3.34; P<.001) more SARS-CoV-2 cases/1000 population on May 15 compared with low-SDI counties, respectively. Deaths per capita were also significantly higher for higher-SDI counties.
Counties with higher social deprivation scores experienced greater growth in SARS-CoV-2 cases and deaths, but reduced mobility at lower rates. These findings are consistent with evidence demonstrating that economically disadvantaged communities have been disproportionately impacted by the coronavirus disease 2019 pandemic. Efforts to socially distance may be more burdensome for these communities, potentially exacerbating disparities in SARS-CoV-2-related outcomes.
研究社会经济劣势程度不同的县之间社区流动性减少和严重急性呼吸综合征冠状病毒 2(SARS-CoV-2)结果的差异。
该样本包括美国在 2020 年 4 月 1 日至 5 月 15 日期间至少有一例 SARS-CoV-2 病例的县。结果是三种情况下 SARS-CoV-2 病例的增长、与 SARS-CoV-2 相关的死亡以及流动性减少:零售/娱乐、杂货店/药店和工作场所。主要解释变量是社会剥夺指数(SDI),这是一种综合的社会经济劣势衡量标准。
使用具有州固定效应的线性回归计算低、中、高 SDI 县(按三分位定义)之间结果的调整差异。与低 SDI 县相比,中 SDI 县和高 SDI 县的工作场所流动性分别降低了 1.75(95%置信区间,-2.36 至-1.14;P<.001)和 3.48 个百分点(95%置信区间,-4.21 至-2.75;P<.001)。其他环境中的流动性减少对于较高 SDI 县也明显较低。在根据 4 月 1 日 SARS-CoV-2 流行情况调整分析中,中 SDI 县和高 SDI 县在 5 月 15 日每 1000 人中有 1.39(95%置信区间,0.85 至 1.93;P<.001)和 2.56(95%置信区间,1.77 至 3.34;P<.001)更多的 SARS-CoV-2 病例,与低 SDI 县相比。人均死亡人数也明显较高 SDI 县更高。
社会剥夺程度较高的县 SARS-CoV-2 病例和死亡人数增长更多,但流动性降低速度较慢。这些发现与表明经济贫困社区不成比例地受到 2019 年冠状病毒病大流行影响的证据一致。社交距离的努力对这些社区来说可能更具负担,可能会加剧与 SARS-CoV-2 相关结果的差异。