An Ecologic Study of Disparities in COVID-19 Incidence and Case Fatality in Oakland County, MI, USA, During a State-Mand
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An Ecologic Study of Disparities in COVID-19 Incidence and Case Fatality in Oakland County, MI, USA, During a State-Mandated Shutdown Maxwell O. Akanbi 1
&
Adovich S. Rivera 2,3
&
Folake O. Akanbi 1 & Adenike Shoyinka 4
Received: 16 August 2020 / Revised: 22 October 2020 / Accepted: 23 October 2020 # W. Montague Cobb-NMA Health Institute 2020
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. Keywords Coronavirus . COVID-19 . Disparities . Epidemiology . USA . African Americans
Introduction In December 2019, an outbreak of pneumonia of unknown etiology emerged in Wuhan, China [1]. The causative agent Supplementary Information The online version contains supplementary material available at https://doi.org/10.1007/s40615-02000909-1. * Maxwell O. Akanbi [email protected]; [email protected] 1
Department of Internal Medicine, McLaren Flint Hospital, 401 South Ballenger Hwy, Flint, MI 48532, USA
2
Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
3
Department of Preventive Medicine, Northwestern University, Chicago, IL, USA
4
Ingham County Health Department, Lansing, MI, USA
was later identified as the severe acute respiratory syndrome coronavirus-2 (SARS COV-2) and the disease was named coronavirus disease 2019 (COVID-19). SARS COV-2 has demonstrated a high degree of infectivity and cases of COVID-19 have been diagnosed in all countries in the world [2]. As of September 20, 2020, over 8.4 million cases of COVID-19 cases had been diagnosed in the USA, with a
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