The relationship between neighborhood poverty and COVID-19 mortality within racial/ethnic groups (Cook County, Illinois)
This article has been Reviewed by the following groups
Listed in
- Evaluated articles (ScreenIT)
- Evaluated articles (Rapid Reviews Infectious Diseases)
Abstract
Background
Prior research has identified higher rates of COVID-19 mortality among people of color (relative to non-Hispanic whites) and populations in high-poverty neighborhoods (relative to wealthier neighborhoods). It is unclear, however, whether non-Hispanic whites in high-poverty neighborhoods experience elevated mortality, or whether people of color living in wealthy areas are relatively protected. Exploring socioeconomic position in combination with race/ethnicity can lead to a more detailed understanding of the specific processes that result in COVID-19 inequities.
Methods and Findings
We used census and individual-level mortality data for the non-Hispanic white, non-Hispanic Black, and Hispanic/Latinx populations of Cook County, Illinois, USA. We excluded deaths related to nursing homes and other institutions. We calculated age and gender-adjusted mortality rates by race/ethnicity, census tract poverty quartile, and age group (0-64 and ≥65 years).
Within all racial/ethnic groups, COVID-19 mortality rates were greatest in the highest-poverty quartile and lowest in the lowest-poverty quartile. The mortality rate for younger non-Hispanic whites in the highest-poverty quartile was 13.5 times that of younger non-Hispanic whites in the lowest-poverty quartile (95% CI: 8.5, 21.4). For young people in the highest-poverty quartile, the non-Hispanic white and Black mortality rates were similar. Among younger people in the lowest-poverty quartile, non-Hispanic Black and Hispanic/Latinx people had mortality rates nearly three times that of non-Hispanic whites. For the older population, the mortality rate among non-Hispanic whites in the highest-poverty quartile was less than that of lowest-poverty non-Hispanic Black and Hispanic/Latinx populations.
Conclusions
Our findings suggest racial/ethnic inequalities in COVID-19 mortality are partly, but not entirely, attributable to the higher average socioeconomic position of non-Hispanic whites relative to the non-Hispanic Black and Hispanic/Latinx populations. Future research on health equity in COVID-19 outcomes should collect and analyze individual-level data on the potential mechanisms driving population distributions of exposure, severe illness, and death.
Article activity feed
-
SciScore for 10.1101/2020.10.04.20206318: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
No key resources detected.
Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:One limitation of our study is that we were not able to remove the population residing in institutions from the denominators in rate calculations because census tract-level data were unavailable in the American Community …
SciScore for 10.1101/2020.10.04.20206318: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
No key resources detected.
Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:One limitation of our study is that we were not able to remove the population residing in institutions from the denominators in rate calculations because census tract-level data were unavailable in the American Community Survey. However, census data for the state of Illinois show that <7% of people ages ≥75 years reside in institutions, suggesting that any resulting bias is likely to be small. Additionally, while the use of area-based poverty measures has been previously validated as a proxy for individual-level socioeconomic position, persons of high socioeconomic position may live in high-poverty neighborhoods and vice versa. Our findings suggest racial/ethnic inequalities in COVID-19 mortality are partly, but not entirely, attributable to the higher average socioeconomic position of NHWs relative to the NHB and Hispanic/Latinx populations. Within poverty quartiles, there may be persistent racial/ethnic differences in COVID-19 risk factors for exposure (e.g. due to occupational hazards and residential crowding) and infection fatality rates (e.g. due to comorbidities and health care access/quality). Future research on health equity in COVID-19 outcomes should collect and analyze individual-level data on the potential mechanisms driving population distributions of exposure, severe illness, and death. In many US jurisdictions, death certificates already contain useful data on educational attainment and employment by occupation and industry, but these have not yet been made pub...
Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We found bar graphs of continuous data. We recommend replacing bar graphs with more informative graphics, as many different datasets can lead to the same bar graph. The actual data may suggest different conclusions from the summary statistics. For more information, please see Weissgerber et al (2015).
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
- No protocol registration statement was detected.
-
Kate Pickett
Review 2: "The relationship between neighborhood poverty and COVID-19 mortality within racial/ethnic groups (Cook County, Illinois)"
This study adds to the literature on disparities in COVID-19 morbidity and mortality, though the data used may preclude some important, finer-grained analyses of different sources of outcome disparities.
-
Eyal Oren, Adrienne Suazo
Review 1: "The relationship between neighborhood poverty and COVID-19 mortality within racial/ethnic groups (Cook County, Illinois)"
This study adds to the literature on disparities in COVID-19 morbidity and mortality, though the data used may preclude some important, finer-grained analyses of different sources of outcome disparities.
-
Strength of evidence
Reviewers: Eyal Oren, Adrienne Suazo (San Diego State University) | 📒📒📒 ◻️ ◻️
Kate Pickett (University of York) | 📗📗📗📗◻️ -
