Samuel Laura J, Gaskin Darrell J, Trujillo Antonio J, Szanton Sarah L, Samuel Andrew, Slade Eric
Johns Hopkins University School of Nursing, 525 North Wolfe St., Rm 426, Baltimore, MD, 21205, USA.
Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
BMC Public Health. 2021 Jun 29;21(1):1250. doi: 10.1186/s12889-021-11205-w.
Communities with more Black or Hispanic residents have higher coronavirus rates than communities with more White residents, but relevant community characteristics are underexplored. The purpose of this study was to investigate poverty-, race- and ethnic-based disparities and associated economic, housing, transit, population health and health care characteristics.
Six-month cumulative coronavirus incidence and mortality were examined using adjusted negative binomial models among all U.S. counties (n = 3142). County-level independent variables included percentages in poverty and within racial/ethnic groups (Black, Hispanic, Native American, Asian), and rates of unemployment, lacking a high school diploma, housing cost burden, single parent households, limited English proficiency, diabetes, obesity, smoking, uninsured, preventable hospitalizations, primary care physicians, hospitals, ICU beds and households that were crowded, in multi-unit buildings or without a vehicle.
Counties with higher percentages of Black (IRR = 1.03, 95% CI: 1.02-1.03) or Hispanic (IRR = 1.02, 95% CI: 1.01-1.03) residents had more coronavirus cases. Counties with higher percentages of Black (IRR = 1.02, 95% CI: 1.02-1.03) or Native American (IRR = 1.02, 95% CI: 1.01-1.04) residents had more deaths. Higher rates of lacking a high school diploma was associated with higher counts of cases (IRR = 1.03, 95% CI: 1.01-1.05) and deaths (IRR = 1.04, 95% CI: 1.01-1.07). Higher percentages of multi-unit households were associated with higher (IRR = 1.02, 95% CI: 1.01-1.04) and unemployment with lower (IRR = 0.96, 95% CI: 0.94-0.98) incidence. Higher percentages of individuals with limited English proficiency (IRR = 1.09, 95% CI: 1.04-1.14) and households without a vehicle (IRR = 1.04, 95% CI: 1.01-1.07) were associated with more deaths.
These results document differential pandemic impact in counties with more residents who are Black, Hispanic or Native American, highlighting the roles of residential racial segregation and other forms of discrimination. Factors including economic opportunities, occupational risk, public transit and housing conditions should be addressed in pandemic-related public health strategies to mitigate disparities across counties for the current pandemic and future population health events.
与白人居民较多的社区相比，黑人或西班牙裔居民较多的社区新冠病毒感染率更高，但相关社区特征尚未得到充分研究。本研究的目的是调查基于贫困、种族和族裔的差异以及相关的经济、住房、交通、人口健康和医疗保健特征。
在美国所有县（n = 3142）中，使用调整后的负二项式模型检查了六个月的累计新冠病毒发病率和死亡率。县级自变量包括贫困率、种族/族裔群体（黑人、西班牙裔、美洲原住民、亚裔）中的比例，以及失业率、未获得高中文凭率、住房成本负担率、单亲家庭率、英语水平有限率、糖尿病、肥胖症、吸烟率、未参保率、可预防的住院率、初级保健医生数量、医院数量、重症监护病床数量，以及居住在多单元建筑中、拥挤或没有车辆的家庭比例。
黑人（发病率比值比[IRR] = 1.03，95%置信区间[CI]：1.02 - 1.03）或西班牙裔居民比例较高的县新冠病毒病例更多。黑人（IRR = 1.02，95% CI：1.02 - 1.03）或美洲原住民居民比例较高的县死亡人数更多。未获得高中文凭率较高与病例数（IRR = 1.03，95% CI：1.01 - 1.05）和死亡人数（IRR = 1.04，95% CI：1.01 - 1.07）较多相关。多单元家庭比例较高与发病率较高（IRR = 1.02，95% CI：1.01 - 1.04）相关，而失业率较高与发病率较低（IRR = 0.96，95% CI：0.94 - 0.98）相关。英语水平有限的个人比例较高（IRR = 1.09，95% CI：1.04 - 1.14）和没有车辆的家庭比例较高（IRR = 1.04，95% CI：1.01 - 1.07）与死亡人数较多相关。
这些结果记录了在黑人、西班牙裔或美洲原住民居民较多的县中疫情影响的差异，突出了居住种族隔离和其他形式歧视的作用。在与疫情相关的公共卫生策略中，应解决包括经济机会、职业风险、公共交通和住房条件等因素，以减轻各县在当前疫情和未来人口健康事件中的差异。
