ABSTRACT
INTRODUCTION: Data from the USA reveal disparities in hospitalization and mortality from coronavirus disease 2019 (COVID-19). Social determinants of health (SDoH) could account for disparities in disease incidence and outcomes. We investigated the association between zip code racial composition and COVID-19 incidence and case fatality in Oakland County, MI. METHODS: We conducted an ecological study using publicly available data on COVID-19 in 70 zip codes in Oakland County, MI. We obtained demographic surrogate markers of SDoH by zip code from the US Census Bureau website. Using negative binomial regression models, we investigated the association between the percentage of Blacks in each zip code and COVID-19 incidence and case fatality, including markers of SDoH as potential confounders. RESULTS: Reported COVID-19 cases ranged from 13.2 to 255.2 per 10,000 population. Each percentage increase in Blacks within a zip code was associated with a 3% increase in COVID-19 cases (95% CI: 1.02 to 1.04, p ≤ 0.0001), and this remained significant after adjusting for income or poverty level, number of persons per household, mode of transportation, age, and level of education (incidence rate ratio: 1.02, 95% CI: 1.01 to 1.03, p ≤ 0.0001). Zip codes with a higher percentage of Blacks also experienced a faster increase in COVID-19 rates from April 3 to May 16. However, the proportion of Blacks in a zip code was not associated with case fatality. CONCLUSION: Zip codes with larger Black populations were disproportionately affected by COVID-19.
Subject(s)
COVID-19/epidemiology , COVID-19/mortality , Health Status Disparities , Black or African American/statistics & numerical data , COVID-19/ethnology , COVID-19/prevention & control , Communicable Disease Control/methods , Humans , Incidence , Michigan/epidemiology , Quarantine , Residence Characteristics/statistics & numerical data , Social Determinants of HealthABSTRACT
In total, 718 consecutive clinical meticillin-resistant Staphylococcus aureus (MRSA) isolates from 2006 to 2010 and 417 clinical meticillin-susceptible S. aureus (MSSA) isolates from mid-2007 to 2010 were evaluated. Isolates were from blood cultures obtained from separate patients in Detroit, MI, and were tested for in vitro susceptibility trends to vancomycin and daptomycin by molecular strain type. The MRSA pulsed-field gel electrophoresis (PFGE) results showed that 290 (40.4%) were USA100, 296 (41.2%) were USA300 and the remaining isolates were non-USA100/300. Vancomycin minimum inhibitory concentrations (MICs) by Etest [mean±standard deviation (S.D.) 1.55±0.26mg/L] in MRSA isolates showed no significant change over the 5-year period within all strain types, whilst daptomycin MICs by Etest (mean±S.D. 0.51±0.25mg/L) showed a significant downward trend across time (r=-0.243; P<0.001), with this trend occurring among all PFGE groups. For MSSA, a significant decrease in MICs to vancomycin was found by Etest (r=-0.160; P=0.001) and conversely a significant increase in daptomycin MICs by Etest was found (r=0.146; P=0.028). The results of this study showed that changes in MIC were not specific to strain molecular type. For vancomycin, there was no change in MRSA MICs and a decrease in MSSA MICs for blood isolates. For daptomycin, MICs decreased in MRSA and increased in MSSA blood isolates over the study period.
