The impact of population mobility on COVID-19 incidence and socioeconomic disparities at the sub-city level in 314 Latin American cities

BackgroundLittle is known about the impact of changes in mobility at the sub-city level on subsequent COVID-19 incidence or the contribution of mobility to socioeconomic disparities in COVID-19 incidence. MethodsWe compiled aggregated mobile phone location data, COVID-19 confirmed cases, and features of the urban and social environments to analyze linkages between population mobility, COVID-19 incidence, and educational attainment at the sub-city level among cities with >100,000 inhabitants in Argentina, Brazil, Colombia, Guatemala, and Mexico from March to August 2020. We used mixed effects negative binomial regression to examine longitudinal associations between changes in weekly mobility (lags 1-6 weeks) and subsequent COVID-19 incidence at the sub-city level, adjusting for urban environmental factors. FindingsAmong 1,031 sub-cities representing 314 cities in five Latin American countries, 10% higher weekly mobility was associated with 8.5% (95% CI 7.4% to 9.5%) higher weekly COVID-19 incidence the following week. This association gradually declined as the lag between mobility and COVID-19 incidence increased and was not different from the null at a six-week lag. We found evidence that suggests differences in mobility reductions are a driver of socioeconomic disparities in COVID-19 incidence. InterpretationLower population movement within a sub-city is associated with lower risk of subsequent COVID-19 incidence among residents of that sub-city. Implementing policies that reduce population mobility at the sub-city level may be an impactful COVID-19 mitigation strategy that takes equity into consideration and reduces economic and social disruption at the city or regional level. FundingWellcome Trust

Declines in life expectancy following the COVID-19 pandemic in provinces of Spain

The COVID-19 pandemic has impacted population health on a global scale. Most of the studies on mortality impacts are at national level, while broad evidence exists on heterogeneous COVID-19 incidence across regions and within countries. Using Spanish data for 2020, we estimate life expectancy changes in 2020 compared with the 2017-19 period in 50 Spanish provinces. We visualize longer-term trends (1990-2020), and compare the robustness of our province-specific results with cumulative COVID-19 incidence using regional data from the Spanish ENECOVID seroprevalence study. In 2020 there was a 1.2 and 1.1 year drop in life expectancy for men and women in Spain, but this impact was heterogeneous across regions. For men these losses were highest in the province of Segovia (-3.5 years decline), while for women the highest drop was observed in Salamanca (-2.8 years decline). Life expectancy actually increased in Santa Cruz de Tenerife (+1.1 and +0.6 years for men and women, respectively). Declines in life expectancy in 2020 were also highly correlated with the cumulative seroprevalence through November 2020 ({rho}=0.80 and 0.77 in men and women, respectively). Monitoring regional life expectancy dynamics provide valuable and granular information on the heterogeneous impacts of the pandemic on health at the population level. Similar exercises in other European countries may reveal insightful geographic patterns in mortality impacts in COVID-19 pandemic years.

Evaluating the impact of keeping indoor dining closed on COVID-19 rates among large US cities: a quasi-experimental design

ObjectiveIndoor dining is one of the potential key drivers of COVID-19 transmission. We leverage the heterogeneity in state government preemption of city indoor dining closures, to estimate the impact of keeping indoor dining closed on COVID-19 incidence. MethodsWe obtained case rates and city/state re-opening dates from March to October 2020 in 11 U.S. cities. We categorized cities as (treatment) cities that were allowed by the state to reopen but kept indoor dining closed; and (comparison) cities that would have kept indoor dining closed but were preempted by their state and had to reopen indoor dining. ResultsKeeping indoor dining closed was associated with a 43% (IRR=0.57, 95% CI 0.46 to 0.69) decline in COVID-19 incidence over 4-weeks compared with cities that reopened indoor dining. These results were consistent after testing alternative modeling strategies. ConclusionsKeeping indoor dining closed contributes to reductions in COVID-19 spread. Policy ImplicationsEvidence of the relationship between indoor dining and COVID-19 incidence can inform state and local decisions to restrict indoor dining as a tailored strategy to reduce COVID-19 incidence.

They're Dying in the Suburbs: COVID-19 Cases and Deaths by Geography in Louisiana (USA)

The national COVID-19 conversation in the US has mostly focused on urban areas, without sufficient examination of another geography with large vulnerable populations: the suburbs. While suburbs are often thought of as areas of uniform affluence and racial homogeneity, over the past 20 years, poverty and diversity have increased substantially in the suburbs. In this study, we compare geographic and temporal trends in COVID-19 cases and deaths in Louisiana, one of the few states with high rates of COVID-19 during both the spring and summer. We find that incidence and mortality rates were initially highest in New Orleans. By the second peak, trends reversed: suburban areas experienced higher rates than New Orleans and similar rates to other urban and rural areas. We also find that increased social vulnerability was associated with increased positivity and incidence during the first peak. During the second peak, these associations reversed in New Orleans while persisting in other urban, suburban, and rural areas. The work draws attention to the high rates of COVID-19 cases and deaths in suburban areas and the importance of metropolitan-wide actions to address COVID-19. RegistrationN/A Funding sourceNIH (DP5OD26429) and RWJF (77644) Code and data availabilityCode for replication along with data is available here: https://github.com/alinasmahl1/COVID_Louisiana_Suburban/.

Monitoring life expectancy levels during the COVID-19 pandemic: Example of the unequal impact in Spanish regions

BackgroundTo provide an interpretable summary of the impact on mortality of the COVID-19 pandemic we estimate weekly and annual life expectancies at birth in Spain and its regions. MethodsWe used daily death count data from the Spanish MoMo, and death counts from 2018, and population on 1 July, 2019 by region (CCAA), age groups, and sex from the Spanish National Statistics Institute. We estimated weekly and annual (2019 and 2020*, the shifted annual calendar period up to June 14th 2020) life expectancies at birth as well as their differences with respect to 2019. ResultsWeekly life expectancies at birth in Spain were lower in weeks 11-20, 2020 compared to the same weeks in 2019. This drop in weekly life expectancy was especially strong in weeks 13 and 14 (March 23rd to April 5th), with national declines ranging between 6.1 and 7.6 years and maximum regional weekly declines of up to 15 years in Madrid. Annual life expectancy differences between 2019 and 2020 also reflected an overall drop in annual life expectancy of 0.8 years for both men and women. These drops ranged between 0 years in several regions (e.g. Canary and Balearic Islands) to 2.7 years among men in Madrid. ConclusionsLife expectancy is an easy to interpret measure for understanding the heterogeneity of mortality patterns across Spanish regions. Weekly and annual life expectancy are sensitive useful indicators for understanding disparities and communicating the gravity of the situation because differences are expressed in intuitive year units. Key messages- Weekly and annual updated life expectancy are valuable indicators of the health impacts of the pandemic in populations. - The impact of the COVID-19 pandemic in Spain has been severe and highly heterogeneous, with weekly life expectancy falls of up to 15 years in Madrid, and with annual life expectancy falls ranging between 0 and 2.7 years. - Our results for Spain provide important insights into the magnitude of the pandemic in mortality levels across regions and are easy to interpret and compare.

Early Evidence of Disparities in COVID-19 Testing in US Cities

BackgroundPreliminary evidence has shown inequities in COVID-19 related cases and deaths in the US. ObjectiveWe explored the emergence of spatial inequities in COVID-19 testing, positivity, confirmed cases, and mortality in New York City, Philadelphia, and Chicago during the first six months of the pandemic. DesignEcological, observational study at the zip code tabulation area (ZCTA) level from March to September 2020. SettingChicago, New York City and Philadelphia. ParticipantsAll populated ZCTAs in the three cities. MeasuresOutcomes were ZCTA-level COVID-19 testing, positivity, confirmed cases, and mortality cumulatively through the end of September. Predictors were the CDC social vulnerability index and its four domains, obtained from the 2014-2018 American Community Survey. We examined the spatial autocorrelation of COVID-19 outcomes using global and local Morans I and estimated associations using spatial conditional autoregressive negative binomial models. ResultsWe found spatial clusters of high and low positivity, confirmed cases and mortality, co-located with clusters of low and high social vulnerability. We also found evidence for the existence of spatial inequities in testing, positivity, confirmed cases and mortality for the three cities. Specifically, neighborhoods with higher social vulnerability had lower testing rates, higher positivity ratios, confirmed case rates and mortality rates. LimitationsZCTAs are imperfect and heterogeneous geographical units of analysis. We rely on surveillance data, which may be incomplete. ConclusionWe found spatial inequities in COVID-19 testing, positivity, confirmed cases, and mortality in three large cities of the US. RegistrationN/A Funding sourceNIH (DP5OD26429) and RWJF (77644)