Socioeconomic Variation in the Relationship Between Neighbourhoods' Built Environments and the Spread of COVID-19 in Toronto, Canada.

The novel coronavirus disease 2019 (COVID-19) pandemic underscores the importance of place of residence as a determinant of health. Prior work has primarily examined the relationship between neighbourhoods' sociodemographic traits and COVID-19 infection rates. Using data from the City of Toronto, Canada, we assess how the built environments of neighbourhoods, in conjunction with their sociodemographic profiles, shape the pattern of spread of COVID-19 in low-, middle-, and high-income neighbourhoods. Our results show that COVID-19 spread faster in neighbourhoods with a higher share of overcrowded households, large commercial areas, and poor walkability. The extent to which neighbourhood walkability is associated with a slower increase in COVID-19 infections varied by neighbourhood income level, with a stronger negative association in low-income neighbourhoods. Net of the share of overcrowded households, population density is associated with a faster increase in COVID-19 infections in low-income neighbourhoods, but slower increase in high-income neighbourhoods. More green space is associated with a slower increase in COVID-19 infections in low-income, but not higher-income, neighbourhoods. Overall, our findings suggest that post-pandemic urban planning efforts cannot adopt a one-size-fits-all policy when reconstructing neighbourhoods in ways that promote health and reduce their vulnerability to infectious diseases. Instead, they should tailor the rebuilding process in ways that address the diverse needs of residents in low-, middle-, and high-income neighbourhoods.