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Health Policy

Associations Between Built Environment, Neighborhood Socioeconomic Status, and SARS-CoV-2 Infection Among Pregnant Women in New York City

Educational Objective
To understand how built environment affects the care pregnant women with COVID-19 receive in New York City
1 Credit CME
JAMA
Published Online: June 18, 2020
Research Letter
Ukachi N. Emeruwa, MD, MPH1;
Samsiya Ona, MD1;
Jeffrey L. Shaman, PhD2;
Amy Turitz, MD1;
Jason D. Wright, MD1;
Cynthia Gyamfi-Bannerman, MD, MSc1;
Alexander Melamed, MD, MPH1
Author Affiliations
  • 1Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, New York
  • 2Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, New York
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The built environment is associated with infectious disease dynamics, particularly in diseases transmitted by contact, aerosols, or droplets.1,2 A recent study of the ongoing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) epidemic in New York revealed significant differences in hospitalization and death rates among the city’s boroughs, with the highest rates in Queens and the Bronx.3 To our knowledge, no studies have investigated associations between the built environment, markers of neighborhood socioeconomic status, and SARS-CoV-2 transmission. We leveraged a universal testing program for SARS-CoV-2 in pregnant women to examine associations between these factors and SARS-CoV-2 prevalence.

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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

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Health Disparities Pregnancy Obstetrics Women's Health Obstetrics and Gynecology Health Policy Population Health Coronavirus (COVID-19)
Article Information

Corresponding Author: Alexander Melamed, MD, MPH, Division of Gynecologic Oncology, Vagelos College of Physicians and Surgeons, Columbia University, 161 Ft Washington Ave, New York, NY 10032 (am5195@cumc.columbia.edu).

Published Online: June 18, 2020. doi:10.1001/jama.2020.11370

Author Contributions: Dr Melamed had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Drs Emeruwa and Ona contributed equally.

Concept and design: Shaman, Turitz, Gyamfi-Bannerman, Melamed.

Acquisition, analysis, or interpretation of data: Emeruwa, Ona, Gyamfi-Bannerman, Wright, Melamed.

Drafting of the manuscript: Emeruwa, Ona, Melamed.

Critical revision of the manuscript for important intellectual content: Emeruwa, Ona, Shaman, Turitz, Gyamfi-Bannerman, Wright.

Statistical analysis: Melamed.

Administrative, technical, or material support: Shaman, Turitz, Gyamfi-Bannerman.

Supervision: Turitz, Melamed.

Conflict of Interest Disclosures: Dr Shaman and Columbia University reported partial ownership of SK Analytics. Dr Shaman reported receiving personal fees from Business Networking International and Merck. Dr Gyamfi-Bannerman reported receiving grants from Eunice Kennedy Shriver National Institute of Child Health and Human Development, the National Heart, Lung, and Blood Institute, and AMAG/Society for Maternal-Fetal Medicine and receiving personal fees from Sera. Dr Wright reported receiving grants from Merck and receiving personal fees from Clovis Oncology. No other disclosures were reported.

Funding/Support: This study was supported by the National Center for Advancing Translational Sciences (KL2TR001874 [Dr Melamed]), the National Institute of General Medical Sciences (1U01GM110748 [Dr Shaman]), the National Science Foundation (DMS-2027369 [Dr Shaman]), National Heart, Lung, and Blood Institute (2R01HL098554 [Dr Gyamfi-Bannerman]), Eunice Kennedy Shriver National Institute of Child Health and Human Development (5UG1HD040485 [Dr Gyamfi-Bannerman]), the Society for Maternal-Fetal Medicine (Dr Gyamfi-Bannerman), and the Morris-Singer Foundation (Dr Shaman).

Role of the Funders/Sponsors: The funders/sponsors had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

References
1.
Pinter-Wollman  N , Jelić  A , Wells  NM .  The impact of the built environment on health behaviours and disease transmission in social systems.   Philos Trans R Soc Lond B Biol Sci. 2018;373(1753):20170245. doi:10.1098/rstb.2017.0245PubMedGoogle Scholar
2.
Virtanen  M , Terho  K , Oksanen  T ,  et al.  Patients with infectious diseases, overcrowding, and health in hospital staff.   Arch Intern Med. 2011;171(14):1296-1298. doi:10.1001/archinternmed.2011.313PubMedGoogle ScholarCrossref
3.
Wadhera  RK , Wadhera  P , Gaba  P , Figueroa  JF , Joynt Maddox  KE , Yeh  RW , Shen  C .  Variation in COVID-19 hospitalizations and deaths across New York City boroughs.   JAMA. 2020;323(21):2192-2195. doi:10.1001/jama.2020.7197PubMedGoogle ScholarCrossref
4.
American Community Survey by neighborhood tabulation area. New York City Department of City Planning. Accessed May 6, 2020. https://www1.nyc.gov/site/planning/data-maps/open-data/dwn-acs-nta.page
5.
PLUTO database. New York City Department of City Planning. Accessed May 6, 2020. https://www1.nyc.gov/site/planning/data-maps/open-data.page
AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

  • 1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
  • 1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
  • 1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
  • 1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
  • 1.00 CME points in the American Board of Surgery’s (ABS) Continuing Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.

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