Geographic inequalities in COVID-19 diagnosis are now well documented. However, we do not sufficiently know whether inequalities are related to social characteristics of communities, such as collective engagement. We tested whether neighborhood social cohesion is associated with inequalities in COVID-19 diagnosis rate and the extent the association varies across neighborhood racial composition. We calculated COVID-19 diagnosis rates in Philadelphia, PA, per 10,000 general population across 46 ZIP codes, as of April 2020. Social cohesion measures were from the Southeastern Pennsylvania Household Health Survey, 2018. We estimated Poisson regressions to quantify associations between social cohesion and COVID-19 diagnosis rate, testing a multiplicative interaction with Black racial composition in the neighborhood, which we operationalize via a binary indicator of ZIP codes above vs. below the city-wide average (41%) Black population. Two social cohesion indicators were significantly associated with COVID-19 diagnosis. Associations varied across Black neighborhood racial composition (p <0.05 for the interaction test). In ZIP codes with ≥41% of Black people, higher collective engagement was associated with an 18% higher COVID-19 diagnosis rate (IRR=1.18, 95%CI=1.11, 1.26). In contrast, areas with <41% of Black people, higher engagement was associated with a 26% lower diagnosis rate (IRR=0.74, 95%CI=0.67, 0.82). Neighborhood social cohesion is associated with both higher and lower COVID-19 diagnosis rates, and the extent of associations varies across Black neighborhood racial composition. We recommend some strategies for reducing inequalities based on the segmentation model within the social cohesion and public health intervention framework.
Background Borrelia miyamotoi is a relapsing fever spirochete that relatively recently has been reported to infect humans. It causes an acute undifferentiated febrile illness that can include meningoencephalitis and relapsing fever. Like Borrelia burgdorferi, it is transmitted by Ixodes scapularis ticks in the northeastern United States and by Ixodes pacificus ticks in the western United States. Despite reports of clinical cases from North America, Europe, and Asia, the prevalence, geographic range, and pattern of expansion of human B. miyamotoi infection are uncertain. To better understand these characteristics of B. miyamotoi in relation to other tickborne infections, we carried out a cross-sectional seroprevalence study across New England that surveyed B. miyamotoi, B. burgdorferi, and Babesia microti infections. Methods We measured specific antibodies against B. miyamotoi, B. burgdorferi, and B. microti among individuals living in 5 New England states in 2018. Results Analysis of 1153 serum samples collected at 11 catchment sites showed that the average seroprevalence for B. miyamotoi was 2.8% (range, 0.6%–5.2%), which was less than that of B. burgdorferi (11.0%; range, 6.8%–15.6%) and B. microti (10.0%; range, 6.5%–13.6%). Antibody screening within county residence in New England showed varying levels of seroprevalence for these pathogens but did not reveal a vectoral geographical pattern of distribution. Conclusions Human infections caused by B. miyamotoi, B. burgdorferi, and B. microti are widespread with varying prevalence throughout New England.
Background Diseases vectored by the tick species Ixodes scapularis have increased in incidence over the past 50 years and have been expanding into previously non-endemic areas. The emergence of Borrelia miyamotoi, a recently described spirochetal pathogen, has been less well documented than that of Borrelia burgdorferi, the causative agent of Lyme disease. The objective of this study was to compare the geographic range of human exposure to B. miyamotoi and B. burgdorferi in New England, the pattern of their spatial expansion, and factors that influence their frequency. Methods Serum samples were collected from 11 study sites across New England. Age, gender, race, and residential zip code or county were recorded for each study participant and aggregate data analyzed by study sites, study site zones, and residential county for spatial analysis. Serum samples were tested for B. miyamotoi antibody using a multiplex Luminex assay and for B. burgdorferi antibody using a recently FDA approved two-tiered ELISA (Zeus ELISA Test Systems). Fischer exact tests and map visualizations in ArcGIS Pro 2.4.2 (Copyright ©2019 Esri Inc.) were used to determine spatial distribution of human B. miyamotoi and B. burgdorferi infection in New England. A logistic regression model was used to determine any association in seropositivity with tick-borne infection risk factors. Results B. burgdorferi seroprevalence was greater than that of B. miyamotoi at all but one study site. The average B. burgdorferi seroprevalence at all study sites was not quite double that of B. miyamotoi (mean 2.3% [0.6-6.2%] and mean 4.1% [2.2-7.5%], respectively). No longitudinal or latitudinal gradient was observed for B. miyamotoi or B. burgdorferi seroprevalence by study site zone or county analysis. Men were twice as likely as women to be seropositive for B. miyamotoi and B. burgdorferi. Conclusion Human exposure to B. miyamotoi and B. burgdorferi is highly dispersed throughout New England. B. miyamotoi seroprevalence is about half that of B. burgdorferi in New England. Additional studies are needed to explain the disparity between B. burgdorferi and B. miyamotoi infection and disease. Disclosures All Authors: No reported disclosures
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