Ghosh Arnab K, Venkatraman Sara, Soroka Orysya, Reshetnyak Evgeniya, Rajan Mangala, An Anjile, Chae John K, Gonzalez Christopher, Prince Jonathan, DiMaggio Charles, Ibrahim Said, Safford Monika M, Hupert Nathaniel
medRxiv. 2021 Jun 22:2021.06.14.21258904. doi: 10.1101/2021.06.14.21258904.
The role of overcrowded and multigenerational households as a risk factor for COVID-19 remains unmeasured. The objective of this study is to examine and quantify the association between overcrowded and multigenerational households, and COVID-19 in New York City (NYC).
We conducted a Bayesian ecological time series analysis at the ZIP Code Tabulation Area (ZCTA) level in NYC to assess whether ZCTAs with higher proportions of overcrowded (defined as proportion of estimated number of housing units with more than one occupant per room) and multigenerational households (defined as the estimated percentage of residences occupied by a grandparent and a grandchild less than 18 years of age) were independently associated with higher suspected COVID-19 case rates (from NYC Department of Health Syndromic Surveillance data for March 1 to 30, 2020). Our main measure was adjusted incidence rate ratio (IRR) of suspected COVID-19 cases per 10,000 population. Our final model controlled for ZCTA-level sociodemographic factors (median income, poverty status, White race, essential workers), prevalence of clinical conditions related to COVID-19 severity (obesity, hypertension, coronary heart disease, diabetes, asthma, smoking status, and chronic obstructive pulmonary disease), and spatial clustering.
39,923 suspected COVID-19 cases presented to emergency departments across 173 ZCTAs in NYC. Adjusted COVID-19 case rates increased by 67% (IRR 1.67, 95% CI = 1.12, 2.52) in ZCTAs in quartile four (versus one) for percent overcrowdedness and increased by 77% (IRR 1.77, 95% CI = 1.11, 2.79) in quartile four (versus one) for percent living in multigenerational housing. Interaction between both exposures was not significant (β = 0.99, 95% CI: 0.99-1.00).
Over-crowdedness and multigenerational housing are independent risk factors for suspected COVID-19. In the early phase of surge in COVID cases, social distancing measures that increase house-bound populations may inadvertently but temporarily increase SARS-CoV-2 transmission risk and COVID-19 disease in these populations.
过度拥挤和多代同堂家庭作为新冠病毒病（COVID-19）的一个风险因素，其作用仍未得到评估。本研究的目的是调查和量化纽约市（NYC）过度拥挤和多代同堂家庭与COVID-19之间的关联。
我们在纽约市邮政编码分区统计区（ZCTA）层面进行了贝叶斯生态时间序列分析，以评估过度拥挤（定义为每间房居住人数超过一人的住房单元估计比例）和多代同堂家庭比例较高（定义为居住着祖父母和18岁以下孙辈的住宅估计百分比）的ZCTA是否与较高的疑似COVID-19病例率独立相关（数据来自纽约市卫生部门2020年3月1日至30日的症状监测数据）。我们的主要指标是每10000人口中疑似COVID-19病例的调整发病率比（IRR）。我们的最终模型控制了ZCTA层面的社会人口学因素（中位数收入、贫困状况、白人种族、一线工作者）、与COVID-19严重程度相关的临床疾病患病率（肥胖、高血压、冠心病、糖尿病、哮喘、吸烟状况和慢性阻塞性肺疾病）以及空间聚集情况。
纽约市173个ZCTA的急诊科共出现39923例疑似COVID-19病例。在过度拥挤百分比处于第四四分位数（相对于第一四分位数）的ZCTA中，调整后的COVID-19病例率增加了67%（IRR 1.67，95%CI = 1.12，2.52）；在多代同堂住房居住百分比处于第四四分位数（相对于第一四分位数）的ZCTA中，调整后的COVID-19病例率增加了77%（IRR 1.77，95%CI = 1.11，2.79）。两种暴露因素之间的交互作用不显著（β = 0.99，95%CI：0.99 - 1.00）。
过度拥挤和多代同堂住房是疑似COVID-19的独立风险因素。在COVID病例激增的早期阶段，增加居家人口的社交距离措施可能会在无意中但暂时增加这些人群中SARS-CoV-2的传播风险和COVID-19疾病的发生风险。
