Greater risk of severe COVID-19 in Black, Asian and Minority Ethnic populations is not explained by cardiometabolic, socioeconomic or behavioural factors, or by 25(OH)-vitamin D status: study of 1326 cases from the UK Biobank

Rivera

J. Racial and Ethnic Health Disparities

et al. 2020

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. Supplementary Information The online version contains supplementary material available at 10.1007/s40615-020-00909-1.

Section: Discussionsupporting

confidence: 90%

An Ecologic Study of Disparities in COVID-19 Incidence and Case Fatality in Oakland County, MI, USA, During a State-Mandated Shutdown

Rivera

J. Racial and Ethnic Health Disparities

et al. 2020

“…The recommendations are silent on the critical issues of employment security, adequate safety nets, and the causes of occupational segregation. Similarly, nothing is said about a longstanding need to reduce household overcrowding, a key candidate for covid-19 transmission 14. Social housing restrictions on local authorities impair adequate housing provision for larger and multigenerational households.…”

mentioning

confidence: 99%

Covid-19 and ethnic minorities: an urgent agenda for overdue action

Khunti

Platt

Routen

et al. 2020

BMJ

“…Women are more likely to avoid crowds and use of public transport than men (9,10); older age is often associated to engagement with SD behaviours (9)(10)(11), though other studies have found no conclusive evidence (12,13). Black, Asian and Minority Ethnic (BAME) populations in the UK have been found to be at greater risk of dying from COVID-19 compared to the white population (14), and evidence suggest this is multi-factorial (material deprivation, increased exposure to risk and structural racism amongst others (15), yet ndings from previous pandemics and COVID-19 suggest that this is not due to poorer adherence to SD measures (16,17). Higher socio-economic status and higher educational attainment are often related to engagement in SD behaviours (10)(11)(12)18), although both low income and having no quali cations have also been associated with greater adherence to SD behaviours in a UK study (16).…”

Section: And the Independent Sagementioning

confidence: 99%

Factors Associated with Non-Adherence to Social Distancing Rules During The COVID-19 Pandemic: A Logistic Regression Analysis

Hills

Eraso

2020

Preprint

Background: On March 23, 2020, the government of the United Kingdom told the British people to stay home, an unprecedented request designed to limit the spread of the COVID-19 virus and stop the National Health Service from being overwhelmed. Methods: This study undertook a cross-sectional design to survey a convenience sample of 681 residents of North London on their social distancing behaviours, demographics, housing situation, politics, psychology and social support using an online questionnaire. Logistic regression was used to measure the associations between these explanatory factors and non-adherence to all social distancing rules and intentional non-adherence to social distancing rules.Results: The majority (92.8%) of participants did not adhere to all social distancing rules and nearly half (48.6%) engaged in intentional non-adherence of rules. The odds of not adhering to all social distancing rules increased if a participant was not identified as highly vulnerable to COVID-19 [OR=4.5], had lower control over others’ distancing [OR=.724], had lower control over responsibilities for which coming into contact with others was unavoidable [OR=.642], and if social distancing behaviours were reported after lockdown was first relaxed [OR=.261]. The odds of intentionally not adhering to social distancing rules increased if a participant had a lower intention to socially distance [OR=.468], had lower control over others’ distancing [OR=.829], had a doctoral degree compared to a master’s degree [OR=.332], a professional qualification [OR=.307], a bachelor’s degree [OR=.361] or work-related qualification [OR=.174], voted for the UK Government compared to not voting for the Government [OR=.461], perceived higher normative pressure from neighbours [OR=1.121] and had greater support from friends [OR=1.465]. Conclusions: Non-adherence to all social distancing rules had a stronger association with vulnerability to COVID-19 and control over social distancing, whereas intentional non-adherence had a stronger association with intention and anti-social psychological factors. It is recommended that people living in high-risk environments, such as those living in houses of multiple occupancy, should be specially supported to not have to leave their home, that public health messaging should emphasise shared responsibility and public consciousness and that there should be greater policing, larger fines and more direct issuing of fines.