The Health Consequences of Urban Scaling

PROJECT Summary: The COVID-19 pandemic has killed more than 100,000 people in the US, where very wide inequities in COVID-19 outcomes have been reported for racial/ethnic minorities, including Hispanics. Hispanics suffer from specificsocial vulnerabilities that lead to increased risk of infection, and increased prevalence specific risk factors thatlead to increased risk of severe illness. However, the number of confirmed cases in Hispanics may be severelyunderestimated due to differential coverage of testing by area and population group. Moreover, most preliminarymeasures of inequities in mortality have ignored the role of the different age structure of racial/ethnic groups.Creating consistent estimates of racial/ethnic inequities in COVID-19 outcomes is therefore key to exploringtrends and predictors of these inequities, as a first step to improve the targeting of future interventions.Concurrently, several non-pharmaceutical interventions (NPI) have been deployed to control the pandemic, Thecapacity of racial/ethnic minorities to adhere to or benefit from (NPI) has been limited by several structuralbarriers, including deficient social safety nets, a lower possibility of teleworking and a higher likelihood of workingin essential occupations. Overall, these structural constraints make isolation more challenging and increase thelikelihood of exposure to infection even in areas with social distancing. Continued viral transmission in specificpopulation subgroups makes the control of the pandemic more challenging for the entire population, and theemergence of future waves more likely. In summary, Hispanics are one of the racial/ethnic groups most impactedby the pandemic and, concurrently, one of the groups least able to benefit from NPI. For the current and futurewaves of the pandemic, it is imperative to reduce the risk of infection across the population to reduce communitytransmission; therefore. Therefore, understanding where and why health inequities are wider and whether NPIwork across different groups is key to preventing future waves by reducing overall levels communitytransmission. We propose to systematically examine trends and predictors of heterogeneities of health inequitiesin COVID-19 outcomes between Hispanics and non-Hispanic whites (NHW), and between the neighborhoodswhere they predominantly live, across and within US cities, and the potential unequal effect of NPI in Hispanicsvs NHW. We will leverage data on COVID-19 outcomes by race/ethnicity and neighborhood from the 30 largestcities of the US, corrected for imperfect testing quality and coverage; (2) social inequality measures; and (3) adiverse set of compilations of state-, county- and city-level policies. By using a heterogeneous sample of cities,we will uncover inequities and predictors of these inequities that will allow for more specific targeting ofinterventions that may prove key in continuing to control current waves of the pandemic and to prevent futurewaves. We will also demonstrate whether NPI may be less effective in Hispanics or predominantly Hispanicneighborhoods. Since NPI remain the most effective tool for epidemic control, their failure on specific populationsubgroups represents a hazard for the entire population.Drexel Internal Data