Cargando…
COVID-19 Cases Among Congregate Care Facility Staff by Neighborhood of Residence and Social and Structural Determinants: Observational Study
BACKGROUND: Disproportionate risks of COVID-19 in congregate care facilities including long-term care homes, retirement homes, and shelters both affect and are affected by SARS-CoV-2 infections among facility staff. In cities across Canada, there has been a consistent trend of geographic clustering...
Autores principales: | , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
JMIR Publications
2022
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9534317/ https://www.ncbi.nlm.nih.gov/pubmed/35867901 http://dx.doi.org/10.2196/34927 |
_version_ | 1784802515926122496 |
---|---|
author | Ma, Huiting Yiu, Kristy C Y Baral, Stefan D Fahim, Christine Moloney, Gary Darvin, Dariya Landsman, David Chan, Adrienne K Straus, Sharon Mishra, Sharmistha |
author_facet | Ma, Huiting Yiu, Kristy C Y Baral, Stefan D Fahim, Christine Moloney, Gary Darvin, Dariya Landsman, David Chan, Adrienne K Straus, Sharon Mishra, Sharmistha |
author_sort | Ma, Huiting |
collection | PubMed |
description | BACKGROUND: Disproportionate risks of COVID-19 in congregate care facilities including long-term care homes, retirement homes, and shelters both affect and are affected by SARS-CoV-2 infections among facility staff. In cities across Canada, there has been a consistent trend of geographic clustering of COVID-19 cases. However, there is limited information on how COVID-19 among facility staff reflects urban neighborhood disparities, particularly when stratified by the social and structural determinants of community-level transmission. OBJECTIVE: This study aimed to compare the concentration of cumulative cases by geography and social and structural determinants across 3 mutually exclusive subgroups in the Greater Toronto Area (population: 7.1 million): community, facility staff, and health care workers (HCWs) in other settings. METHODS: We conducted a retrospective, observational study using surveillance data on laboratory-confirmed COVID-19 cases (January 23 to December 13, 2020; prior to vaccination rollout). We derived neighborhood-level social and structural determinants from census data and generated Lorenz curves, Gini coefficients, and the Hoover index to visualize and quantify inequalities in cases. RESULTS: The hardest-hit neighborhoods (comprising 20% of the population) accounted for 53.87% (44,937/83,419) of community cases, 48.59% (2356/4849) of facility staff cases, and 42.34% (1669/3942) of other HCW cases. Compared with other HCWs, cases among facility staff reflected the distribution of community cases more closely. Cases among facility staff reflected greater social and structural inequalities (larger Gini coefficients) than those of other HCWs across all determinants. Facility staff cases were also more likely than community cases to be concentrated in lower-income neighborhoods (Gini 0.24, 95% CI 0.15-0.38 vs 0.14, 95% CI 0.08-0.21) with a higher household density (Gini 0.23, 95% CI 0.17-0.29 vs 0.17, 95% CI 0.12-0.22) and with a greater proportion working in other essential services (Gini 0.29, 95% CI 0.21-0.40 vs 0.22, 95% CI 0.17-0.28). CONCLUSIONS: COVID-19 cases among facility staff largely reflect neighborhood-level heterogeneity and disparities, even more so than cases among other HCWs. The findings signal the importance of interventions prioritized and tailored to the home geographies of facility staff in addition to workplace measures, including prioritization and reach of vaccination at home (neighborhood level) and at work. |
format | Online Article Text |
id | pubmed-9534317 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | JMIR Publications |
record_format | MEDLINE/PubMed |
spelling | pubmed-95343172022-10-06 COVID-19 Cases Among Congregate Care Facility Staff by Neighborhood of Residence and Social and Structural Determinants: Observational Study Ma, Huiting Yiu, Kristy C Y Baral, Stefan D Fahim, Christine Moloney, Gary Darvin, Dariya Landsman, David Chan, Adrienne K Straus, Sharon Mishra, Sharmistha JMIR Public Health Surveill Original Paper BACKGROUND: Disproportionate risks of COVID-19 in congregate care facilities including long-term care homes, retirement homes, and shelters both affect and are affected by SARS-CoV-2 infections among facility staff. In cities across Canada, there has been a consistent trend of geographic clustering of COVID-19 cases. However, there is limited information on how COVID-19 among facility staff reflects urban neighborhood disparities, particularly when stratified by the social and structural determinants of community-level transmission. OBJECTIVE: This study aimed to compare the concentration of cumulative cases by geography and social and structural determinants across 3 mutually exclusive subgroups in the Greater Toronto Area (population: 7.1 million): community, facility staff, and health care workers (HCWs) in other settings. METHODS: We conducted a retrospective, observational study using surveillance data on laboratory-confirmed COVID-19 cases (January 23 to December 13, 2020; prior to vaccination rollout). We derived neighborhood-level social and structural determinants from census data and generated Lorenz curves, Gini coefficients, and the Hoover index to visualize and quantify inequalities in cases. RESULTS: The hardest-hit neighborhoods (comprising 20% of the population) accounted for 53.87% (44,937/83,419) of community cases, 48.59% (2356/4849) of facility staff cases, and 42.34% (1669/3942) of other HCW cases. Compared with other HCWs, cases among facility staff reflected the distribution of community cases more closely. Cases among facility staff reflected greater social and structural inequalities (larger Gini coefficients) than those of other HCWs across all determinants. Facility staff cases were also more likely than community cases to be concentrated in lower-income neighborhoods (Gini 0.24, 95% CI 0.15-0.38 vs 0.14, 95% CI 0.08-0.21) with a higher household density (Gini 0.23, 95% CI 0.17-0.29 vs 0.17, 95% CI 0.12-0.22) and with a greater proportion working in other essential services (Gini 0.29, 95% CI 0.21-0.40 vs 0.22, 95% CI 0.17-0.28). CONCLUSIONS: COVID-19 cases among facility staff largely reflect neighborhood-level heterogeneity and disparities, even more so than cases among other HCWs. The findings signal the importance of interventions prioritized and tailored to the home geographies of facility staff in addition to workplace measures, including prioritization and reach of vaccination at home (neighborhood level) and at work. JMIR Publications 2022-10-04 /pmc/articles/PMC9534317/ /pubmed/35867901 http://dx.doi.org/10.2196/34927 Text en ©Huiting Ma, Kristy C Y Yiu, Stefan D Baral, Christine Fahim, Gary Moloney, Dariya Darvin, David Landsman, Adrienne K Chan, Sharon Straus, Sharmistha Mishra. Originally published in JMIR Public Health and Surveillance (https://publichealth.jmir.org), 04.10.2022. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Public Health and Surveillance, is properly cited. The complete bibliographic information, a link to the original publication on https://publichealth.jmir.org, as well as this copyright and license information must be included. |
spellingShingle | Original Paper Ma, Huiting Yiu, Kristy C Y Baral, Stefan D Fahim, Christine Moloney, Gary Darvin, Dariya Landsman, David Chan, Adrienne K Straus, Sharon Mishra, Sharmistha COVID-19 Cases Among Congregate Care Facility Staff by Neighborhood of Residence and Social and Structural Determinants: Observational Study |
title | COVID-19 Cases Among Congregate Care Facility Staff by Neighborhood of Residence and Social and Structural Determinants: Observational Study |
title_full | COVID-19 Cases Among Congregate Care Facility Staff by Neighborhood of Residence and Social and Structural Determinants: Observational Study |
title_fullStr | COVID-19 Cases Among Congregate Care Facility Staff by Neighborhood of Residence and Social and Structural Determinants: Observational Study |
title_full_unstemmed | COVID-19 Cases Among Congregate Care Facility Staff by Neighborhood of Residence and Social and Structural Determinants: Observational Study |
title_short | COVID-19 Cases Among Congregate Care Facility Staff by Neighborhood of Residence and Social and Structural Determinants: Observational Study |
title_sort | covid-19 cases among congregate care facility staff by neighborhood of residence and social and structural determinants: observational study |
topic | Original Paper |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9534317/ https://www.ncbi.nlm.nih.gov/pubmed/35867901 http://dx.doi.org/10.2196/34927 |
work_keys_str_mv | AT mahuiting covid19casesamongcongregatecarefacilitystaffbyneighborhoodofresidenceandsocialandstructuraldeterminantsobservationalstudy AT yiukristycy covid19casesamongcongregatecarefacilitystaffbyneighborhoodofresidenceandsocialandstructuraldeterminantsobservationalstudy AT baralstefand covid19casesamongcongregatecarefacilitystaffbyneighborhoodofresidenceandsocialandstructuraldeterminantsobservationalstudy AT fahimchristine covid19casesamongcongregatecarefacilitystaffbyneighborhoodofresidenceandsocialandstructuraldeterminantsobservationalstudy AT moloneygary covid19casesamongcongregatecarefacilitystaffbyneighborhoodofresidenceandsocialandstructuraldeterminantsobservationalstudy AT darvindariya covid19casesamongcongregatecarefacilitystaffbyneighborhoodofresidenceandsocialandstructuraldeterminantsobservationalstudy AT landsmandavid covid19casesamongcongregatecarefacilitystaffbyneighborhoodofresidenceandsocialandstructuraldeterminantsobservationalstudy AT chanadriennek covid19casesamongcongregatecarefacilitystaffbyneighborhoodofresidenceandsocialandstructuraldeterminantsobservationalstudy AT straussharon covid19casesamongcongregatecarefacilitystaffbyneighborhoodofresidenceandsocialandstructuraldeterminantsobservationalstudy AT mishrasharmistha covid19casesamongcongregatecarefacilitystaffbyneighborhoodofresidenceandsocialandstructuraldeterminantsobservationalstudy |