Session
COVID-19 and Social Determinants
APHA 2022 Annual Meeting and Expo
Abstract
Association between provider access and COVID-19 immunizations: the role of social vulnerability index
APHA 2022 Annual Meeting and Expo
Background: Michigan has reported lower COVID-19 vaccination coverage in areas with high social vulnerability index (SVI).
Objective: To explore associations between vaccination coverage and vaccine providers at the census-tract level.
Methods: We used data from the Michigan Care Improvement Registry (MCIR) to estimate COVID-19 vaccination coverage for children and adults, and to count providers within a 1-mile radius of each census tract throughout the state. We fit linear regression models to estimate the association between the number of COVID-19 providers and vaccination coverage and explored SVI as a potential effect modifier of this association.
Results: Overall, census tracts averaged 12 COVID-19 vaccine providers including 4 pharmacies, and 2.5 pediatric providers. Higher SVI areas had more providers (total 15 vs 12, p < 0.001), apart from pediatric providers (2.5 vs 2.5, p = 0.5). However, coverage was lower for high SVI tracts among both adults (47 vs 61%) and children (12 vs 21%) compared to lower SVI tracts (p < 0.001). We found small but significant increases in coverage for each additional provider for both children (1.0%, 95% CI 0.8-1.1) and adults (0.2%, 95% CI 0.18-0.29). We found larger associations between providers and coverage in lower SVI tracts (p < 0.001).
Conclusion: An increasing number of providers is associated with increasing vaccine coverage in lower SVI areas. However, in higher SVI areas additional interventions may be necessary. Possible interventions to increase coverage include addressing vaccine confidence through trusted messengers and other structural barriers impacting access to care (e.g., paid time off).
Abstract
Association of county-level social vulnerability with COVID-19 testing: The case of South Carolina in the United States
APHA 2022 Annual Meeting and Expo
Background: Descriptive statistics have revealed the geographic disparities in COVID-19 testing in South Carolina (SC), but the underlying mechanisms remain unknown. This study aims to determine the association between county-level social vulnerability and low COVID-19 testing rates across 46 counties in SC.
Methods: SC county-level COVID-19 testing data, obtained from the SC Department of Health and Environment Control between March 2020 to October 2021, were linked with the Socio Vulnerability Index (SVI) data via county FIPS. The four subindices of SVI, including Socioeconomic Vulnerability (SEV), Household Composition and Disability (HCD), Racial/Ethnic Minority Status and Language (RML), and Housing Type and Transportation (HTT), reflect areas’ susceptibility to the COVID-19 pandemic from different perspectives. The present study used the generalized linear mixed model with Poisson distribution to explore the relationship between these four SVI subindices and monthly COVID-19 testing in SC.
Results: As of October 2021, there were 3,323,049 COVID-19 testing cases in SC. Serial cross-sectional results indicate that an increase of 1 point in HTT (IRR, 0.978; 95% CI, 0.977-0.979) was associated with the largest decrease in the COVID-19 testing rate (2.2%). One point increase in SEV was associated with a 1.6% decrease in testing (IRR, 0.984; 95% CI, 0.893-0.985). Additionally, RML (IRR, 0.996; 95% CI, 0.995-0.997) and HCD (IRR, 0.997; 95% CI, 0.996-0.998) were also negatively related to low COVID-19 testing rate.
Conclusions: Community-based strategies to improve COVID-19 testing rates should target counties with high socio vulnerability, particularly those showing vulnerability in socioeconomic status, housing type, and transportation.
Abstract
The role of housing characteristics in racial and ethnic disparities in SARS-CoV-2 antibody seropositivity among New York City adults: a population representative study
APHA 2022 Annual Meeting and Expo
Background: Black and Latino populations have been disproportionately burdened by COVID-19 morbidity and mortality.
Objective: Our paper aims to assess whether affordable housing, crowding, and neighborhood poverty mediate the relationship between race and ethnicity and SARS-CoV-2 antibody seropositivity among New York City (NYC) adults.
Methods: We analyzed data from a SARS-CoV-2 serosurvey (n=1074), nested within the 2020 cross-sectional NYC Community Health Survey (June-October 2020). We defined SARS-CoV-2 seropositivity as either a positive blood test for SARS-CoV-2 antibodies or a self-reported positive test result. We used causal mediation analyses to test whether affordable housing, crowding, and neighborhood poverty mediate a relationship between race and ethnicity and seropositivity.
Results: After controlling for potential confounding, we found elevated prevalence ratios of SARS-CoV-2 seropositivity among Black (APR=1.74, 95% CI=1.10-2.73) and Latino (APR=1.58, 95% CI=1.05-2.37) residents compared with White residents and for those living in crowded housing (APR=1.48, 95% CI=1.03-2.12) and high-poverty neighborhoods (APR=1.54, 95% CI= 1.12-2.11) but not for affordable housing. We observed statistically significant natural direct effects for all three mediators. While living in crowded housing and high-poverty neighborhoods positively contributed to racial and ethnic disparities in seropositivity, contribution from living in affordable housing was estimated to be -9% (Black) and -14% (Latino).
Conclusion: We found that the role of living in affordable housing in racial and ethnic disparities in COVID-19 infection was different from that of crowding and neighborhood poverty. Living in affordable housing could be a protective factor against COVID-19 seropositivity among Black and Latino versus White residents.
Abstract
Travelers’ Health in Houston During the COVID-19 Pandemic: Gaps and Lessons Learned
APHA 2022 Annual Meeting and Expo
Background: Houston is the fourth-largest city in the US and George Bush Intercontinental Airport (IAH) is among the largest and busiest airports in the US. While international travel declined during the pandemic, travelers with COVID infections and exposures transited through IAH.
Objective: This review aims to evaluate the impact of the traveler’s health surveillance project and the challenges that lie ahead to manage air travelers during epidemics or pandemics.
Methods: HHD in consultation with CDC and other health departments expanded its capacity to communicate, test, and provide needed accommodation for air travelers. Rapid molecular COVID-19 testing was offered on-site and travelers who tested positive were contacted and monitored. HHD developed a Qualtrics and travelers’ survey to optimize its communication and service to the air travelers.
Results: During the Omicron variant surge for the first quarter of 2022, HHD traced 103 travelers transiting through IAH from more than 15 countries and provided transportation and accommodation to half of the travelers. Only one airport and airline participated in testing, suggesting that asymptomatic travelers or airline staff may be missed from isolation or quarantine processes. However, as the pandemic intensified, the burden of response fell entirely on HHD and impacted HHD’s ability to manage multiple collaborations across different areas all at once.
Conclusion: Controlling the spread of infection from travelers in airport settings needs a collaborative approach among health departments, airlines, airport agencies, testing centers, and the CDC. The technological infrastructure needed requires multilayered reporting and surveillance in near real-time.