TY  - JOUR
AU  - Bauer, Cici
AU  - Zhang, Kehe
AU  - Lee, Miryoung
AU  - Fisher-Hoch, Susan
AU  - Guajardo, Esmeralda
AU  - McCormick, Joseph
AU  - de la Cerda, Isela
AU  - Fernandez, Maria E
AU  - Reininger, Belinda
PY  - 2021
DA  - 2021/8/5
TI  - Census Tract Patterns and Contextual Social Determinants of Health Associated With COVID-19 in a Hispanic Population From South Texas: A Spatiotemporal Perspective
JO  - JMIR Public Health Surveill
SP  - e29205
VL  - 7
IS  - 8
KW  - COVID-19
KW  - spatial pattern
KW  - social determinants of health
KW  - Bayesian
KW  - underserved population
KW  - health inequity
AB  - 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. 
SN  - 2369-2960
UR  - https://publichealth.jmir.org/2021/8/e29205
UR  - https://doi.org/10.2196/29205
UR  - http://www.ncbi.nlm.nih.gov/pubmed/34081608
DO  - 10.2196/29205
ID  - info:doi/10.2196/29205
ER  -