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.
Index: Black/African American, COVID-19, Ecological, Inequality, Racial disparities, Social capital, Social cohesion, Spatial, Structural determinants