Geographic disparities in COVID-19 testing and outcomes in Florida

Abstract

Background Understanding geographic disparities in Coronavirus Disease 2019 (COVID-19) testing and outcomes at the local level during the early stages of the pandemic can guide policies, inform allocation of control and prevention resources, and provide valuable baseline data to evaluate the effectiveness of interventions for mitigating health, economic and social impacts. Therefore, the objective of this study was to identify geographic disparities in COVID-19 testing, incidence, hospitalizations, and deaths during the first five months of the pandemic in Florida. Methods Florida county-level COVID-19 data for the time period March-July 2020 were used to compute various COVID-19 metrics including testing rates, positivity rates, incidence risks, percent of hospitalized cases, hospitalization risks, case-fatality rates, and mortality risks. High or low risk clusters were identified using either Kulldorff’s circular spatial scan statistics or Tango’s flexible spatial scan statistics and their locations were visually displayed using QGIS. Results Visual examination of spatial patterns showed high estimates of all COVID-19 metrics for Southern Florida. Similar to the spatial patterns, high-risk clusters for testing and positivity rates and all COVID-19 outcomes (i.e. hospitalizations and deaths) were concentrated in Southern Florida. The distributions of these metrics in the other parts of Florida were more heterogeneous. For instance, testing rates for parts of Northwest Florida were well below the state median (11,697 tests/100,000 persons) but they were above the state median for North Central Florida. The incidence risks for Northwest Florida were equal to or above the state median incidence risk (878 cases/100,000 persons), but the converse was true for parts of North Central Florida. Consequently, a cluster of high testing rates was identified in North Central Florida, while a cluster of low testing rate and 1–3 clusters of high incidence risks, percent of hospitalized cases, hospitalization risks, and case fatality rates were identified in Northwest Florida. Central Florida had low-rate clusters of testing and positivity rates but it had a high-risk cluster of percent of hospitalized cases. Conclusions Substantial disparities in the spatial distribution of COVID-19 outcomes and testing and positivity rates exist in Florida, with Southern Florida counties generally having higher testing and positivity rates and more severe outcomes (i.e. hospitalizations and deaths) compared to Northern Florida. These findings provide valuable baseline data that is useful for assessing the effectiveness of preventive interventions, such as vaccinations, in various geographic locations in the state. Future studies will need to assess changes in spatial patterns over time at lower geographical scales and determinants of any identified patterns.

An ecological study of COVID-19 outcomes among Florida counties

“…In Florida, links between geographic factors and COVID-19 outcomes have previously been identified [27,28]. Here, we further explore these associations by comprehensively investigating the interplay between demographic, socioeconomic, and public health factors.…”

“…Socioeconomically disadvantaged communities often bear a greater burden during epidemics [23,24], and disparities were evident during the COVID-19 pandemic [25,26]. In Florida, links between geographic factors and COVID-19 outcomes have previously been identified [27,28]. Here, we further explore these associations by comprehensively investigating the interplay between demographic, socioeconomic, and public health factors.…”

Gender/Sex Disparities in the COVID-19 Cascade from Testing to Mortality: An Intersectional Analysis of Swiss Surveillance Data

“…This vulnerability stems from a combination of factors, including limited access to healthcare, higher exposure risks due to living and working conditions, occupational hazards, and lifestyle habits, coupled with higher comorbidities rates (57). Previous studies show that those in lower SEP areas experienced lower testing rates–particularly pronounced in the pandemic’s early stages–and faced elevated rates of case incidence, hospitalizations, and mortality, a trend reported globally (1–5, 9, 58–60).…”

Geographic disparities and temporal changes of COVID-19 hospitalization risks in North Dakota

“…Since this program was effective in controlling COVID-19 risks ( 9 ), similar programs could help to manage COVID-19 in other tribal areas and public health communities. Similar to AI people, non-Hispanic Black people are more likely to be hospitalized due to COVID-19 than non-Hispanic White people due to underlying health disparities ( 37 , 43 – 45 ). Counties in the western part of the state have relatively high percentages of non-Hispanic Black populations which could have contributed to the high hospitalization risks observed in those areas.…”