Time-varying associations between COVID-19 case incidence and community-level sociodemographic, occupational, environmental, and mobility risk factors in Massachusetts

BACKGROUND: Associations between community-level risk factors and COVID-19 incidence are used to identify vulnerable subpopulations and target interventions, but the variability of these associations over time remains largely unknown. We evaluated variability in the associations between community-level predictors and COVID-19 case incidence in 351 cities and towns in Massachusetts from March to October 2020. METHODS: Using publicly available sociodemographic, occupational, environmental, and mobility datasets, we developed mixed-effect, adjusted Poisson regression models to depict associations between these variables and town-level COVID-19 case incidence data across five distinct time periods. We examined town-level demographic variables, including z-scores of percent Black, Latinx, over 80 years and undergraduate students, as well as factors related to occupation, housing density, economic vulnerability, air pollution (PM(2.5)), and institutional facilities. RESULTS: Associations between key predictor variables and town-level incidence varied across the five time periods. We observed reductions over time in the association with percentage Black residents (IRR=1.12 CI=(1.12–1.13) in spring, IRR=1.01 CI=(1.00–1.01) in fall). The association with number of long-term care facility beds per capita also decreased over time (IRR=1.28 CI=(1.26–1.31) in spring, IRR=1.07 CI=(1.05–1.09)in fall). Controlling for other factors, towns with higher percentages of essential workers experienced elevated incidence of COVID-19 throughout the pandemic (e.g., IRR=1.30 CI=(1.27–1.33) in spring, IRR=1.20, CI=(1.17–1.22) in fall). Towns with higher percentages of Latinx residents also had sustained elevated incidence over time (e.g., IRR=1.19 CI=(1.18–1.21) in spring, IRR=1.14 CI=(1.13–1.15) in fall). CONCLUSIONS: Town-level COVID-19 risk factors vary with time. In Massachusetts, racial (but not ethnic) disparities in COVID-19 incidence have decreased over time, perhaps indicating greater success in risk mitigation in selected communities. Our approach can be used to evaluate effectiveness of public health interventions and target specific mitigation efforts on the community level.