Social and policy determinants and impacts on COVID-19 and influenza disparities

PROJECT SUMMARY The purpose of this K01 proposal is to provide Alina Schnake-Mahl, ScD MPH with the protected time and resources to pursue the additional training needed to reach her long-term goal of an independent academic career in health policy and social epidemiology, focused on generating evidence to inform law and policies that reduce health inequities in infectious diseases. This proposal builds on Dr. Schnake-Mahl's background as a social epidemiologist with expertise in health policy. It also leverages her experience with applied health care research and evaluation, and a cohesive mentorship team, to improve our understanding of the social determinants of COVID-19 and influenza disparities. Over 878,000 people have been hospitalized for COVID- 19 over the last year, and between 140,000 to 710,000 people are hospitalized for flu annually. Studies have found wide disparities in COVID-19 and influenza, but gaps remain with respect to the interactions between the social determinants of these disparities. This project uses diverse and multi-disciplinary approaches to examine the determinants of disparities and effects of policy exposures on disparities. The specific aims are to: 1) use multilevel analysis to describe the social determinants of racial and geographic disparities in influenza and COVID-19 outcomes in US cities; 2) use non-experimental causal inference methods to estimate the effect of PSL and rent control laws on rates and disparities of influenza and COVID-19 outcomes in US cities; 3) use agent based modeling to understand mechanisms linking two key social determinants, occupational exposures and housing overcrowding, and influenza disparities. The training goals are designed to expand skills and knowledge through training in infectious disease epidemiology, casual inference methods for policy analysis, and systems approaches including agent-based modeling. Training in this set of complementary approaches will position the candidate to pursue innovative research in the area of infectious disease disparities as part of a future R01. The proposed work has substantial potential to make a significant public health impact as these aims will advance our understanding of the social determinants of COVID-19 and influenza disparities and provide a strong evidence-base for policies and interventions that may address these inequities and reduce the overall burden of COVID-19 and influenza. Furthermore, this K01 develops specific topic area (infectious disease) and methods (advanced causal inference for policy analysis and systems dynamics) expertise whose extension to other infectious disease indicates applicability beyond the scope of this proposal. The proposed work is feasible and realistic within the award period and will allow Dr. Schnake-Mahl to continue to build research skills, extend professional networks, generate numerous publications, and compete for other NIH funding. In summary, this K01 award will support and stimulate the career development activities of Dr. Schnake Mahl and allow her to successfully move into the next phase of her career as an independent investigator.