Community predictors of COVID‐19 cases and deaths in Massachusetts: Evaluating changes over time using geospatially refined data

Abstract

Background The COVID‐19 pandemic has highlighted the need for targeted local interventions given substantial heterogeneity within cities and counties. Publicly available case data are typically aggregated to the city or county level to protect patient privacy, but more granular data are necessary to identify and act upon community‐level risk factors that can change over time. Methods Individual COVID‐19 case and mortality data from Massachusetts were geocoded to residential addresses and aggregated into two time periods: “Phase 1” (March–June 2020) and “Phase 2” (September 2020 to February 2021). Institutional cases associated with long‐term care facilities, prisons, or homeless shelters were identified using address data and modeled separately. Census tract sociodemographic and occupational predictors were drawn from the 2015–2019 American Community Survey. We used mixed‐effects negative binomial regression to estimate incidence rate ratios (IRRs), accounting for town‐level spatial autocorrelation. Results Case incidence was elevated in census tracts with higher proportions of Black and Latinx residents, with larger associations in Phase 1 than Phase 2. Case incidence associated with proportion of essential workers was similarly elevated in both Phases. Mortality IRRs had differing patterns from case IRRs, decreasing less substantially between Phases for Black and Latinx populations and increasing between Phases for proportion of essential workers. Mortality models excluding institutional cases yielded stronger associations for age, race/ethnicity, and essential worker status. Conclusions Geocoded home address data can allow for nuanced analyses of community disease patterns, identification of high‐risk subgroups, and exclusion of institutional cases to comprehensively reflect community risk.

Inequities in COVID-19 vaccine and booster coverage across Massachusetts ZIP codes: large gaps persist after the 2021/22 Omicron wave

“…These data also show where MA should focus its efforts: vaccinating younger adults 20-39 years, vaccinating children (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19), and ensuring high, equitable booster coverage among middle-aged and older adults. Recent data indicate that vaccines for children are effective in reducing hospitalizations.…”

“…30 ZIP codes with larger percentages of essential workers and larger shares of Black, Latino, and Indigenous residents had lower coverage of both the primary series vaccine (for younger adults and children) and the booster (for all age groups). In MA, these groups have experienced disproportionate infection rates, morbidity, and mortality from COVID-19 [13][14][15] and would therefore be expected to benefit more from vaccination than other groups that are less likely to be exposed to COVID and/or less likely to experience severe illness. State and local public health officials have sought to increase vaccination among Black, Latino, and Indigenous MA residents through the Vaccine Equity Initiative 8 and to increase vaccination of essential workers through mandates.…”

“…In multivariable models, ZIP code income and education levels maintained strong positive associations with vaccine and booster coverage, with income strongly associated with vaccination of children (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19) and young adults (20-39 years). After adjusting for income and education, ZIP codes with more essential workers and with larger Black, Latino, or Indigenous populations had similar or higher vaccination coverage across all age groups, in contrast to the bivariate models.…”

“…Essential workers were defined based on definitions developed by the American Civil Liberties Union, which identified those job types considered "essential" during the pandemic such as work in healthcare, transportation, and food preparation 25 and has been used to assess COVID-19 inequities in MA. [13][14][15] We aggregated to postal ZIP codes using the tract-to-ZIP crosswalk, weighting by tract population. Using the Census ACS estimates we derived zip code level "percent college graduates over the age of 25 years", "percent Black, Latino, or Indigenous", "percent essential workers", and "median household income".…”

“…7 These communities were identified based on COVID-19 case rates, CDC-defined social vulnerability, and the share Black, Indigenous, and people of color. 8 These populations, as well as the overlapping population of essential workers, have been at elevated risk for COVID exposure, infection, morbidity, and mortality throughout the pandemic [9][10][11][12][13][14][15] . The VEI allocated has awarded $46.5 million to 167 community organizations to support vaccine education and outreach.…”