RESUMO
BACKGROUND: Disparities in adverse COVID-19 health outcomes have been associated with multiple social and environmental stressors. However, research is needed to evaluate the consistency and efficiency of methods for studying these associations at local scales. OBJECTIVE: To assess socioexposomic associations with COVID-19 outcomes across New Jersey and evaluate consistency of findings from multiple modeling approaches. METHODS: We retrieved data for COVID-19 cases and deaths for the 565 municipalities of New Jersey up to the end of the first phase of the pandemic, and calculated mortality rates with and without long-term-care (LTC) facility deaths. We considered 84 spatially heterogeneous environmental, demographic and socioeconomic factors from publicly available databases, including air pollution, proximity to industrial sites/facilities, transportation-related noise, occupation and commuting, neighborhood and housing characteristics, age structure, racial/ethnic composition, poverty, etc. Six geostatistical models (Poisson/Negative-Binomial regression, Poison/Negative-Binomial mixed effect model, Poisson/Negative-Binomial Bersag-York-Mollie spatial model) and two Machine Learning (ML) methods (Random Forest, Extreme Gradient Boosting) were implemented to assess association patterns. The Shapley effects plot was established for explainable ML and change of support validation was introduced to compare performances of different approaches. RESULTS: We found robust positive associations of COVID-19 mortality with historic exposures to NO2, population density, percentage of minority and below high school education, and other social and environmental factors. Exclusion of LTC deaths does not significantly affect correlations for most factors but findings can be substantially influenced by model structures and assumptions. The best performing geostatistical models involved flexible structures representing data variations. ML methods captured association patterns consistent with the best performing geostatistical models, and furthermore detected consistent nonlinear associations not captured by geostatistical models. SIGNIFICANCE: The findings of this work improve the understanding of how social and environmental disparities impacted COVID-19 outcomes across New Jersey.
RESUMO
COVID-19 created an unprecedented global public health crisis during 2020-2021. The severity of the fast-spreading infection, combined with uncertainties regarding the physical and biological processes affecting transmission of SARS-CoV-2, posed enormous challenges to healthcare systems. Pandemic dynamics exhibited complex spatial heterogeneities across multiple scales, as local demographic, socioeconomic, behavioral and environmental factors were modulating population exposures and susceptibilities. Before effective pharmacological interventions became available, controlling exposures to SARS-CoV-2 was the only public health option for mitigating the disease; therefore, models quantifying the impacts of heterogeneities and alternative exposure interventions on COVID-19 outcomes became essential tools informing policy development. This study used a stochastic SEIR framework, modeling each of the 21 New Jersey counties, to capture important heterogeneities of COVID-19 outcomes across the State. The models were calibrated using confirmed daily deaths and SQMC optimization and subsequently applied in predictive and exploratory modes. The predictions achieved good agreement between modeled and reported death data; counterfactual analysis was performed to assess the effectiveness of layered interventions on reducing exposures to SARS-CoV-2 and thereby fatality of COVID-19. The modeling analysis of the reduction in exposures to SARS-CoV-2 achieved through concurrent social distancing and face-mask wearing estimated that 357 [IQR (290, 429)] deaths per 100,000 people were averted.