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ASSOCIATION BETWEEN SPATIAL MISMATCH AND COVID-19 POSITIVITY RATES IN COOK COUNTY
Journal of General Internal Medicine ; 37:S236-S237, 2022.
Article in English | EMBASE | ID: covidwho-1995794
ABSTRACT

BACKGROUND:

The spatial mismatch hypothesis (SMH) postulates that the discrepancy between where Black workers live and where they have access to jobs can lead to higher unemployment and worse economic outcomes. This gap exists due to structural factors such as redlining and hiring discrimination. As one of the most salient structural factors preventing economic mobility, the SMH provides a novel lens for examining racial disparities during the COVID19 pandemic. This study explores whether there is an association between measures of spatial mismatch and COVID-19 positivity rates by neighborhood racial composition.

METHODS:

We conducted a retrospective cohort study of patients tested for COVID-19 at an academic medical center and five community-based testing sites in Chicago (March 12-June 25, 2020). Analyses were limited to patients living in Black or White majority neighborhoods, and those with missing data were removed. Each patient's residential address was geocoded to the census block group level and paired with neighborhood race/ethnicity data (majority Black or White) from the 2018 American Community Survey. The dependent variable was COVID-19 positivity, defined by a PCR-positive sample and extracted from the electronic health record. The primary independent variables were neighborhood racial composition and three different measures of SMH at the block group level-commute time, public transportation usage, and neighborhood low-wage job rate. Mixed effects logistic regression models were used to assess COVID-19 positivity as an independent function of block group racial composition and SMH variables, adjusting for patient sociodemographic factors and insurance type.

RESULTS:

Among 21,285 patients tested for COVID-19, data on 14,488 patients from 1,752 block groups were analyzed. Patients were predominantly non-Hispanic Black (69.2%), female (60.9%), and ages 50-64 (23.8%). There were significant differences in the patterns of neighborhood racial composition and SMH measures. For example, <10% of patients living in a White majority neighborhood (n=347) also lived in a neighborhood with high travel time (>75th percentile) to work. Patients living in a Black majority neighborhood had 2.06 times higher adjusted odds (95% CI, 1.76-2.42) of COVID-19 positivity relative to those in a White majority neighborhood. High travel time (AOR=1.35;95% CI, 1.12-1.64), high public transportation usage (AOR=1.24, 95% CI, 1.01-1.51), and low neighborhood low-wage job rate (AOR=1.32;95% CI, 1.05-1.65) were associated with higher COVID-19 positivity. In a cumulative model, spatial mismatch accounted for 12.6% of the disparity in COVID positivity.

CONCLUSIONS:

The SMH accounted for a small but significant proportion of the racial disparity in COVID-19 positivity among patients at an academic medical center in Chicago. The impact of spatial mismatch should be explored for other health outcomes, particularly chronic disease, to quantify its contribution to health disparities and better target interventions.
Keywords

Full text: Available Collection: Databases of international organizations Database: EMBASE Language: English Journal: Journal of General Internal Medicine Year: 2022 Document Type: Article

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Full text: Available Collection: Databases of international organizations Database: EMBASE Language: English Journal: Journal of General Internal Medicine Year: 2022 Document Type: Article