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Geographical concentration of COVID-19 cases by social determinants of health in 16 large metropolitan areas in Canada - a cross-sectional study
Yiqing Xia; Huiting Ma; Gary Moloney; Héctor A. Velásquez García; Monica Sirski; Naveed Z. Janjua; David Vickers; Tyler Williamson; Alan Katz; Kristy Yu; Rafal Kustra; David L. Buckeridge; Marc Brisson; Stefan D. Baral; Sharmistha Mishra; Mathieu Maheu-Giroux.
  • Yiqing Xia; Unity Health Toronto
  • Huiting Ma; Unity Health Toronto
  • Gary Moloney; Unity Health Toronto
  • Héctor A. Velásquez García; British Columbia Centre for Disease Control
  • Monica Sirski; University of Manitoba
  • Naveed Z. Janjua; British Columbia Centre for Disease Control
  • David Vickers; University of Calgary
  • Tyler Williamson; University of Calgary
  • Alan Katz; University of Manitoba
  • Kristy Yu; Unity Health Toronto
  • Rafal Kustra; University of Toronto
  • David L. Buckeridge; McGill University
  • Marc Brisson; Université Laval
  • Stefan D. Baral; Johns Hopkins School of Public Health
  • Sharmistha Mishra; University of Toronto
  • Mathieu Maheu-Giroux; McGill University
Preprint in English | medRxiv | ID: ppmedrxiv-21261039
ABSTRACT
BackgroundThere is a growing recognition that strategies to reduce SARS-CoV-2 transmission should be responsive to local transmission dynamics. Studies have revealed inequalities along social determinants of health, but little investigation was conducted surrounding geographic concentration within cities. We quantified social determinants of geographic concentration of COVID-19 cases across sixteen census metropolitan areas (CMA) in four Canadian provinces. MethodsWe used surveillance data on confirmed COVID-19 cases at the level of dissemination area. Gini (co-Gini) coefficients were calculated by CMA based on the proportion of the population in ranks of diagnosed cases and each social determinant using census data (income, education, visible minority, recent immigration, suitable housing, and essential workers) and the corresponding share of cases. Heterogeneity was visualized using Lorenz (concentration) curves. ResultsGeographic concentration was observed in all CMAs (half of the cumulative cases were concentrated among 21-35% of each citys population) with the greatest geographic heterogeneity in Ontario CMAs (Gini coefficients, 0.32-0.47), followed by British Columbia (0.23-0.36), Manitoba (0.32), and Quebec (0.28-0.37). Cases were disproportionately concentrated in areas with lower income, education attainment, and suitable housing; and higher proportion of visible minorities, recent immigrants, and essential workers. Although a consistent feature across CMAs was concentration by proportion visible minorities, the magnitude of concentration by social determinants varied across CMAs. InterpretationThe feature of geographical concentration of COVID-19 cases was consistent across CMAs, but the pattern by social determinants varied. Geographically-prioritized allocation of resources and services should be tailored to the local drivers of inequalities in transmission in response to SARS-CoV-2s resurgence.
Full text: Available Collection: Preprints Database: medRxiv Type of study: Prevalence study / Randomized controlled trials Language: English Year: 2021 Document Type: Preprint

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Full text: Available Collection: Preprints Database: medRxiv Type of study: Prevalence study / Randomized controlled trials Language: English Year: 2021 Document Type: Preprint