@Article{info:doi/10.2196/29205,
author="Bauer, Cici
and Zhang, Kehe
and Lee, Miryoung
and Fisher-Hoch, Susan
and Guajardo, Esmeralda
and McCormick, Joseph
and de la Cerda, Isela
and Fernandez, Maria E
and Reininger, Belinda",
title="Census Tract Patterns and Contextual Social Determinants of Health Associated With COVID-19 in a Hispanic Population From South Texas: A Spatiotemporal Perspective",
journal="JMIR Public Health Surveill",
year="2021",
month="Aug",
day="5",
volume="7",
number="8",
pages="e29205",
keywords="COVID-19; spatial pattern; social determinants of health; Bayesian; underserved population; health inequity",
abstract="Background: Previous studies have shown that various social determinants of health (SDOH) may have contributed to the disparities in COVID-19 incidence and mortality among minorities and underserved populations at the county or zip code level. Objective: This analysis was carried out at a granular spatial resolution of census tracts to explore the spatial patterns and contextual SDOH associated with COVID-19 incidence from a Hispanic population mostly consisting of a Mexican American population living in Cameron County, Texas on the border of the United States and Mexico. We performed age-stratified analysis to identify different contributing SDOH and quantify their effects by age groups. Methods: We included all reported COVID-19--positive cases confirmed by reverse transcription--polymerase chain reaction testing between March 18 (first case reported) and December 16, 2020, in Cameron County, Texas. Confirmed COVID-19 cases were aggregated to weekly counts by census tracts. We adopted a Bayesian spatiotemporal negative binomial model to investigate the COVID-19 incidence rate in relation to census tract demographics and SDOH obtained from the American Community Survey. Moreover, we investigated the impact of local mitigation policy on COVID-19 by creating the binary variable ``shelter-in-place.'' The analysis was performed on all COVID-19--confirmed cases and age-stratified subgroups. Results: Our analysis revealed that the relative incidence risk (RR) of COVID-19 was higher among census tracts with a higher percentage of single-parent households (RR=1.016, 95{\%} posterior credible intervals [CIs] 1.005, 1.027) and a higher percentage of the population with limited English proficiency (RR=1.015, 95{\%} CI 1.003, 1.028). Lower RR was associated with lower income (RR=0.972, 95{\%} CI 0.953, 0.993) and the percentage of the population younger than 18 years (RR=0.976, 95{\%} CI 0.959, 0.993). The most significant association was related to the ``shelter-in-place'' variable, where the incidence risk of COVID-19 was reduced by over 50{\%}, comparing the time periods when the policy was present versus absent (RR=0.506, 95{\%} CI 0.454, 0.563). Moreover, age-stratified analyses identified different significant contributing factors and a varying magnitude of the ``shelter-in-place'' effect. Conclusions: In our study, SDOH including social environment and local emergency measures were identified in relation to COVID-19 incidence risk at the census tract level in a highly disadvantaged population with limited health care access and a high prevalence of chronic conditions. Results from our analysis provide key knowledge to design efficient testing strategies and assist local public health departments in COVID-19 control, mitigation, and implementation of vaccine strategies. ",
issn="2369-2960",
doi="10.2196/29205",
url="https://publichealth.jmir.org/2021/8/e29205",
url="https://doi.org/10.2196/29205",
url="http://www.ncbi.nlm.nih.gov/pubmed/34081608"
}