Social Determinants of Health Mediate COVID-19 Disparities in South Florida
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Department of Public Health Sciences, University of Miami, Miami, FL, USA; 2GRECC, Geriatric Research Education and Clinical Center, Veterans Affairs Medical Center, Miami, FL, USA; 3Division of Cardiology, University of Miami, Miami, FL, USA.
BACKGROUND: There are several reports of health disparities related to COVID-19. Understanding social determinants of health (SDoH) could help develop mitigation strategies to prevent further COVID-19 spread. Our aim is to evaluate self-reported and census-based SDoH as a mediator of health disparities in COVID-19. METHODS: We conducted a cross-sectional ecological study and included all COVID-19 cases report by the COVID-19 Florida dashboard as the dependent variable. The independent variables were census-based median household income, population and household size, and self-reported SDoH using a validated survey. We calculated the incidence rate ratio (IRR) of COVID-19 by zip code using Poisson regression and structured equation modelling to evaluate the mediation effect of income and SDoH on COVID-19 cases. RESULTS: We included 97,594 COVID-19 positive cases across 79 Miami-Dade ZIP codes with a median age of 43 years; females represented 50.7% of the cases. The highest IRR (4.44) were for ZIP code 33125 (income $21,106, 6% Black, 93% Hispanic), while the lowest IRR (0.86) was for ZIP code 33146 (median household incomes $96,609, 3% Black and 53% Hispanic). In structured equation models, the indirect coefficient of income in the relationship between race/ethnicity and COVID-19 were only significant for Blacks and not Hispanics. CONCLUSIONS: This ecological analysis using ZIP code and aggregate individual-level SDoH shows that in MiamiDade county, COVID infection is associated with economic disadvantage in a particular geographical area and not with racial/ethnic distribution.J Gen Intern Med DOI: 10.1007/s11606-020-06341-9 © Society of General Internal Medicine 2020
INTRODUCTION
In New York and Chicago, the age-adjusted COVID-19 mortality is greater for Blacks and Hispanics compared with NonHispanic Whites.1 The same trends are emerging in several other states as the pandemic spreads through the USA.2 A recent study from a large health system in California found Social Determinants of Health Mediate COVID-19 Supplementary Information The online version contains supplementary material available at https://doi.org/10.1007/s11606-020-06341-9. Received June 2, 2020 Accepted October 31, 2020
that African American patients were more than twice as likely to be hospitalized for COVID-19 when compared to NonHispanic White patients. Government officials and scientific journals call for large-scale contextualization of the COVID19 data to understand these disparities and avoid misunderstandings that undermine efforts to reduce inequities.3 Even though a growing number of voices are recognizing the role that social determinants of health (SDoH) may be playing in the COVID-19 health disparities, there is a lack of consistent data to evaluate and understand these relationships.1 Ult
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