Overcrowded Housing Increases Risk for COVID‐19 Mortality: An Ecological Study

Abstract

Research Objective COVID‐19 has devastated the United States (US) population and exacerbated existing health inequalities. Those residing in areas of high population density are at an elevated risk, suggesting that residence in an overcrowded household may result in heightened vulnerability. However, as the association between residing in an overcrowded household and risk of mortality from COVID‐19 is unknown, the purpose of this study was to analyze this relationship. Study Design COVID‐19 data for Los Angeles County was acquired, along with data on housing and demographics. Overcrowded households were defined as having 1.0+ persons per room. Bivariate regression was then performed, followed by backwards stepwise linear regression. This included overcrowded housing as a predictor variable and COVID‐19 death totals as an outcome variable. Collinearity was assessed via the variance inflation factors (VIF); variables were removed if they had a VIF >8. Population Studied Population‐level data was retrieved for each of the 85 cities in Los Angeles county, the region with the highest number of COVID‐19 cases in the US. Data for this population came from the Los Angeles County Government, as well as the US Census Bureau. Principal Findings Bivariate regression indicated that the number of overcrowded households was positively associated with total COVID‐19 deaths (standardized β = 0.844, p < 0.001). COVID‐19 case totals, number of individuals aged 60 or above, and number of overcrowded households met conditions for inclusion in the backwards stepwise linear regression model. This analysis revealed all independent variables were positively associated with number of deaths, with the largest effect being seen with overcrowded housing (standardized β1 = 0.386, p = 0.001), followed by number of cases (standardized β2 = 0.307, p = 0.014), and number of individuals aged 60+ (standardized β3 = 0.282, p < 0.001). Conclusions Overcrowded housing was found to be a major risk factor for COVID‐19 mortality and served as a better predictor of number of deaths in a city than the number of people 60+, and even the total number of COVID‐19 cases. Implications for Policy or Practice These findings have important implications for addressing the COVID‐19 pandemic. While age and comorbidities have frequently been described as risk factors for poor outcomes, these findings indicate a critical need for COVID‐19 control efforts to more thoroughly assess for overcrowded housing. The striking absence of research and data collection on overcrowded housing indicates a clear direction for future studies.

Spatio-temporal epidemiology and associated indicators of COVID-19 (wave-I and II) in India

“…The household density and COVID-19 cases and deaths overlapped in the spatial analysis. Household density and overcrowded households are significant risk factors for COVID-19 incidence and mortality 45 , 46 . In India, 37% of households have only a single room.…”

Linking Crowding with the Social and Neurological Phenomenon: A Social Requirement

“…Crowded households lead to poor ventilation which can increase susceptibility to contraction of diseases and reduced immunity putting these adults at risk for more diseases. During the Covid-19 lockdown crowded households made it hard for those residing in the homes to self-isolate, putting them at a high risk of its contraction of Covid-19 virus leading to more deaths (Varshney & Adalbert, 2021). In a study conducted on crowded dormitories in a Chinese University with low ventilation rates, cases of respiratory infections were seen to be reported more (Sun, Wang, Zang & Sundell, 2011).…”