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Assessment of Community-Level Disparities in Coronavirus Disease 2019 (COVID-19) Infections and Deaths in Large US Metropolitan Areas

Educational Objective
To understand how to assess community-level disparities in COVID-19 infections and deaths in large US metropolitan areas
1 Credit CME

Urban counties in large metropolitan areas in the United States are among the most affected by the coronavirus disease 2019 (COVID-19) pandemic, with high proportions of confirmed infection among those who have been tested.1 While there is growing evidence of disparities by race/ethnicity across neighborhoods,2,3 the extent to which neighborhood poverty is associated with infection and deaths is not clear. In this cross-sectional study, we examined the association of neighborhood race/ethnicity and poverty with COVID-19 infections and related deaths in urban US counties, hypothesizing disproportionate burdens in counties with a larger percentage of the population belonging to minority racial/ethnic groups and a higher rate of poverty. This study is among the first to investigate such associations in US metropolitan areas.

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Article Information

Accepted for Publication: July 1, 2020.

Published: July 28, 2020. doi:10.1001/jamanetworkopen.2020.16938

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2020 Adhikari S et al. JAMA Network Open.

Corresponding Author: Samrachana Adhikari, PhD, Department of Population Health, New York University Grossman School of Medicine, 180 Madison Ave, 4th Floor, Ste 454, New York, NY 10016 (samrachana.adhikari@nyulangone.org).

Author Contributions: Dr Adhikari and Mr Pantaleo had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Dr Adhikari and Mr Pantaleo contributed equally.

Concept and design: Adhikari, Pantaleo, Feldman, Ogedegbe, Thorpe.

Acquisition, analysis, or interpretation of data: Adhikari, Pantaleo, Troxel.

Drafting of the manuscript: Adhikari, Pantaleo, Ogedegbe.

Critical revision of the manuscript for important intellectual content: Adhikari, Pantaleo, Feldman, Thorpe, Troxel.

Statistical analysis: Adhikari, Pantaleo, Troxel.

Obtained funding: Adhikari.

Administrative, technical, or material support: Feldman, Thorpe.

Supervision: Adhikari.

Conflict of Interest Disclosures: None reported.

Funding/Support: This work was supported by funding from Johnson & Johnson and by the National Institute on Minority Health and Health Disparities of the National Institutes of Health under award number U54MD000538 to Dr Adhikari.

Role of the Funder/Sponsor: The funders 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.

Disclaimer: Dr Ogedegbe is an associate editor of JAMA Network Open, but he was not involved in any of the decisions regarding review of the manuscript or its acceptance. The content is solely the responsibility of the authors and does not necessarily represent the official views of Johnson & Johnson or the National Institutes of Health.

References
1.
US Centers for Disease Control and Prevention. Coronavirus disease 2019 (COVID-19): cases in the U.S. Accessed July 6, 2020. https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in-us.html
2.
Gross  CP , Essien  UR , Gross  JR , Wang  S-y , Nunez-Smith  M .  Racial and ethnic disparities in population level COVID-19 mortality.  medRxiv. Preprint posted online May 11, 2020. doi:10.1101/2020.05.07.20094250
3.
Wadhera  RK , Wadhera  P , Gaba  P ,  et al.  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.
US Census Bureau. Metropolitan and micropolitan. Accessed July 6, 2020. https://www.census.gov/programs-surveys/metro-micro.html
5.
US Census Bureau. SAIPE state and county estimates for 2018. Accessed July 6, 2020. https://www.census.gov/data/datasets/2018/demo/saipe/2018-state-and-county.html
6.
USA Facts. Coronavirus locations: COVID-19 map by county and state. Accessed July 6, 2020. https://usafacts.org/visualizations/coronavirus-covid-19-spread-map/
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