Racial, Ethnic, and Geographic Disparities in Novel Coronavirus (Severe Acute Respiratory Syndrome Coronavirus 2) Test Positivity in North Carolina.

Abstract

Background

Emerging evidence suggests that black and Hispanic communities in the United States are disproportionately affected by coronavirus disease 2019 (COVID-19). A complex interplay of socioeconomic and healthcare disparities likely contribute to disproportionate COVID-19 risk.

Methods

We conducted a geospatial analysis to determine whether individual- and neighborhood-level attributes predict local odds of testing positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We analyzed 29 138 SARS-CoV-2 tests within the 6-county catchment area for Duke University Health System from March to June 2020. We used generalized additive models to analyze the spatial distribution of SARS-CoV-2 positivity. Adjusted models included individual-level age, gender, and race, as well as neighborhood-level Area Deprivation Index, population density, demographic composition, and household size.

Results

Our dataset included 27 099 negative and 2039 positive unique SARS-CoV-2 tests. The odds of a positive SARS-CoV-2 test were higher for males (odds ratio [OR], 1.43; 95% credible interval [CI], 1.30-1.58), blacks (OR, 1.47; 95% CI, 1.27-1.70), and Hispanics (OR, 4.25; 955 CI, 3.55-5.12). Among neighborhood-level predictors, percentage of black population (OR, 1.14; 95% CI, 1.05-1.25), and percentage Hispanic population (OR, 1.23; 95% CI, 1.07-1.41) also influenced the odds of a positive SARS-CoV-2 test. Population density, average household size, and Area Deprivation Index were not associated with SARS-CoV-2 test results after adjusting for race.

Conclusions

The odds of testing positive for SARS-CoV-2 were higher for both black and Hispanic individuals, as well as within neighborhoods with a higher proportion of black or Hispanic residents-confirming that black and Hispanic communities are disproportionately affected by SARS-CoV-2.

Department

Description

Provenance

Citation

Published Version (Please cite this version)

10.1093/ofid/ofaa413

Publication Info

Turner, Nicholas A, William Pan, Viviana S Martinez-Bianchi, Gabriela M Maradiaga Panayotti, Arrianna M Planey, Christopher W Woods and Paul M Lantos (2021). Racial, Ethnic, and Geographic Disparities in Novel Coronavirus (Severe Acute Respiratory Syndrome Coronavirus 2) Test Positivity in North Carolina. Open forum infectious diseases, 8(1). p. ofaa413. 10.1093/ofid/ofaa413 Retrieved from https://hdl.handle.net/10161/22415.

This is constructed from limited available data and may be imprecise. To cite this article, please review & use the official citation provided by the journal.

Scholars@Duke

Turner

Nicholas Turner

Assistant Professor of Medicine
Pan

William Kuang-Yao Pan

Elizabeth Brooks Reid and Whitelaw Reid Associate Professor

William Pan, DrPH, Elizabeth Brooks Reid and Whitelaw Reid Professor of Population Studies and Global Environmental Health, joined the faculty at Duke in 2011. He holds a joint appointment at DGHI and the Nicholas School of Environment, and is Adjunct Professor in the Department of International Health at Johns Hopkins Bloomberg School of Public Health. He is a biostatistician with expertise in spatial analysis, demography land use science, infectious disease epidemiology and environmental health.  He has over 20-years of experience leading large, multi-institutional and interdisciplinary research teams to study the impact of human-environment dynamics influencing human health in low- and middle-income countries (LMICs).  His work is primarily focused in Latin America, particularly the Amazon region.  His current research focuses on: (1) studying the health effects of mercury and other chemical exposures from artisanal and small-scale gold mining (ASGM); (2) developing tools for forecasting vector-borne disease risk, focusing particularly on the integration and modeling of climate, land use, population and malaria surveillance data; (3) studying the role of migration and social network connectivity influencing infectious disease transmission; (4) understanding the risk of lead exposure among hunters and their families, and to identify solutions to mitigate that risk; and (5) evaluating multi-faceted benefits of nature-based solutions related to agroforestry, climate resilience, livelihoods, and disease mitigation.

Martinez-Bianchi

Viviana Sandra Martinez-Bianchi

Associate Professor in Family Medicine and Community Health

Health Disparities, Access to Health Care, Women's Health, Latino Health Care, Chronic Disease Management, Socioeconomic Determinants of Health. Population Health.

Woods

Christopher Wildrick Woods

Wolfgang Joklik Distinguished Professor of Global Health

1. Emerging Infections
2. Global Health
3. Epidemiology of infectious diseases
4. Clinical microbiology and diagnostics
5. Bioterrorism Preparedness
6. Surveillance for communicable diseases
7. Antimicrobial resistance

Lantos

Paul Michael Lantos

Professor of Medicine

I am interested in the spatial epidemiology of infectious diseases. My research utilizes geographic information systems (GIS) and geostatistical analyses to understand the spatial and spatiotemporal distribution of diseases, and their relationship with environmental and demographic factors. I currently have active studies evaluating the spatial distribution of numerous domestic and international infectious diseases, including SARS-CoV-2 (COVID-19), cytomegalovirus, influenza, and Lyme disease. Additionally I am interested in maternal-child health, and I have a number of ongoing studies of neighborhood health disparities in obstetrical care and birth outcomes. I am interested in GIS education and have conducted workshops on public health GIS in Mongolia and China.


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