ABSTRACT
Objectives: To describe vaccine and booster uptake by neighborhood-level factors in California. Methods: We examined trends in COVID-19 vaccination up to September 21, 2021, and boosters up to March 29, 2022 using data from the California Department of Public Health. Quasi-Poisson regression was used to model the association between neighborhood-level factors and fully vaccinated and boosted among ZIP codes. Sub-analyses on booster rates were compared among the 10 census regions. Results: In a minimally adjusted model, a higher proportion of Black residents was associated with lower vaccination (HR = 0.97; 95%CI: 0.96-0.98). However, in a fully adjusted model, proportion of Black, Hispanic/Latinx, and Asian residents were associated with higher vaccination rates (HR = 1.02; 95%CI: 1.01-1.03 for all). The strongest predictor of low vaccine coverage was disability (HR = 0.89; 95%CI: 0.86-0.91). Similar trends persisted for booster doses. Factors associated with booster coverage varied by region. Conclusions: Examining neighborhood-level factors associated with COVID-19 vaccination and booster rates uncovered significant variation within the large and geographically and demographically diverse state of California. Equity-based approaches to vaccination must ensure a robust consideration of multiple social determinants of health.
ABSTRACT
Background: Scant research, including in the United States, has quantified relationships between the political ideologies of elected representatives and COVID-19 outcomes among their constituents. Methods: We analyzed observational cross-sectional data on COVID-19 mortality rates (age-standardized) and stress on hospital intensive care unit (ICU) capacity for all 435 US Congressional Districts (CDs) in a period of adult vaccine availability (April 2021-March 2022). Political metrics comprised: (1) ideological scores based on each US Representative's and Senator's concurrent overall voting record and their specific COVID-19 votes, and (2) state trifectas (Governor, State House, and State Senate under the same political party control). Analyses controlled for CD social metrics, population density, vaccination rates, the prevalence of diabetes and obesity, and voter political lean. Findings: During the study period, the higher the exposure to conservatism across several political metrics, the higher the COVID-19 age-standardized mortality rates, even after taking into account the CD's social characteristics; similar patterns occurred for stress on hospital ICU capacity for Republican trifectas and US Senator political ideology scores. For example, in models mutually adjusting for CD political and social metrics and vaccination rates, Republican trifecta and conservative voter political lean independently remained significantly associated with an 11%-26% higher COVID-19 mortality rate. Interpretation: Associations between the political ideologies of US federal elected officials and state concentrations of political party power with population health warrant greater consideration in public health analyses and monitoring dashboards. Funding: This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.
ABSTRACT
PURPOSE: To examine neighborhood-level disparities in SARS-CoV-2 molecular test percent positivity in New York City (NYC) by demographics and socioeconomic status over time to better understand COVID-19 inequities. METHODS: Across 177 neighborhoods, we calculated the Spearman correlation of neighborhood characteristics with SARS-CoV-2 molecular test percent positivity during March 1-July 25, 2020 by five periods defined by trend in case counts: increasing, declining, and three plateau periods to account for differential testing capacity and reopening status. RESULTS: Percent positivity was positively correlated with neighborhood racial and ethnic characteristics and socioeconomic status, including the proportion of the population who were Latino and Black non-Latino, uninsured, Medicaid enrollees, transportation workers, or had low educational attainment. Correlations were generally consistent over time despite increasing testing rates. Neighborhoods with high proportions of these correlates had median percent positivity values of 62.6%, 28.7%, 6.4%, 2.8%, and 2.2% in the five periods, respectively, compared with 40.6%, 11.7%, 1.7%, 0.9%, and 1.0% in neighborhoods with low proportions of these correlates. CONCLUSIONS: Disparities in SARS-CoV-2 molecular test percent positivity persisted in disadvantaged neighborhoods during multiple phases of the first few months of the COVID-19 epidemic in NYC. Mitigation of the COVID-19 burden is still urgently needed in disproportionately affected communities.