Urban environments and COVID-19 in three Eastern states of the United States.

The United States has the highest numbers of confirmed cases and deaths during the novel coronavirus disease 2019 (COVID-19) pandemic. Previous studies reported that urban residents are more vulnerable to the spread and mortality of COVID-19 than rural residents. However, the pathways through which urban environments affect COVID-19 spread and mortality are unclear. We collected daily data on the number of confirmed cases and deaths of COVID-19 from Mar. 01 to Nov. 16, 2020 for all 91 counties in New York, New Jersey, and Connecticut in the United States. We calculated the COVID-19 incidence %, daily reproduction number, and mortality %, then estimated the associations with urban environment indicators using regression models. COVID-19 outcomes were generally highest in areas with high population density, and this pattern was evident in the early period of epidemic. Among the area-level demographic variables, the percentage of Black or Hispanic residents showed the strongest positive association with COVID-19 outcomes. Higher risk of COVID-19 outcomes was also associated with higher percentage of overcrowded households, uninsured people, and income inequality. The percent elderly, sex ratio (the ratio of males to females), and greenness were negatively associated with risk of COVID-19 outcomes. The results of this study could indicate where resources are most needed.