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      Differential impact of mitigation policies and socioeconomic status on COVID-19 prevalence and social distancing in the United States


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          The spread of COVID-19 has highlighted the long-standing health inequalities across the U.S. as neighborhoods with fewer resources were associated with higher rates of COVID-19 transmission. Although the stay-at-home order was one of the most effective methods to contain its spread, residents in lower-income neighborhoods faced barriers to practicing social distancing. We aimed to quantify the differential impact of stay-at-home policy on COVID-19 transmission and residents’ mobility across neighborhoods of different levels of socioeconomic disadvantage.


          This was a comparative interrupted time-series analysis at the county level. We included 2087 counties from 38 states which both implemented and lifted the state-wide stay-at-home order. Every county was assigned to one of four equally-sized groups based on its levels of disadvantage, represented by the Area Deprivation Index. Prevalence of COVID-19 was calculated by dividing the daily number of cumulative confirmed COVID-19 cases by the number of residents from the 2010 Census. We used the Social Distancing Index (SDI), derived from the COVID-19 Impact Analysis Platform, to measure the mobility. For the evaluation of implementation, the observation started from Mar 1st 2020 to 1 day before lifting; and, for lifting, it ranged from 1 day after implementation to Jul 5th 2020. We calculated a comparative change of daily trends in COVID-19 prevalence and Social Distancing Index between counties with three highest disadvantage levels and those with the least level before and after the implementation and lifting of the stay-at-home order, separately.


          On both stay-at-home implementation and lifting dates, COVID-19 prevalence was much higher among counties with the highest or lowest disadvantage level, while mobility decreased as the disadvantage level increased. Mobility of the most disadvantaged counties was least impacted by stay-at-home implementation and relaxation compared to counties with the most resources; however, disadvantaged counties experienced the largest relative increase in COVID-19 infection after both stay-at-home implementation and relaxation.


          Neighborhoods with varying levels of socioeconomic disadvantage reacted differently to the implementation and relaxation of COVID-19 mitigation policies. Policymakers should consider investing more resources in disadvantaged counties as the pandemic may not stop until most neighborhoods have it under control.

          Supplementary Information

          The online version contains supplementary material available at 10.1186/s12889-021-11149-1.

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          Most cited references17

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          Interrupted time series regression for the evaluation of public health interventions: a tutorial

          Abstract Interrupted time series (ITS) analysis is a valuable study design for evaluating the effectiveness of population-level health interventions that have been implemented at a clearly defined point in time. It is increasingly being used to evaluate the effectiveness of interventions ranging from clinical therapy to national public health legislation. Whereas the design shares many properties of regression-based approaches in other epidemiological studies, there are a range of unique features of time series data that require additional methodological considerations. In this tutorial we use a worked example to demonstrate a robust approach to ITS analysis using segmented regression. We begin by describing the design and considering when ITS is an appropriate design choice. We then discuss the essential, yet often omitted, step of proposing the impact model a priori. Subsequently, we demonstrate the approach to statistical analysis including the main segmented regression model. Finally we describe the main methodological issues associated with ITS analysis: over-dispersion of time series data, autocorrelation, adjusting for seasonal trends and controlling for time-varying confounders, and we also outline some of the more complex design adaptations that can be used to strengthen the basic ITS design.
            • Record: found
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            Economic and social consequences of human mobility restrictions under COVID-19

            Significance This paper presents a large-scale analysis of the impact of lockdown measures introduced in response to the spread of novel coronavirus disease 2019 (COVID-19) on socioeconomic conditions of Italian citizens. We leverage a massive near–real-time dataset of human mobility and we model mobility restrictions as an exogenous shock to the economy, similar to a natural disaster. We find that lockdown measures have a twofold effect: First, their impact on mobility is stronger in municipalities with higher fiscal capacity; second, they induce a segregation effect: mobility contraction is stronger in municipalities where inequality is higher and income per capita is lower. We highlight the necessity of fiscal measures that account for these effects, targeting poverty and inequality mitigation.
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              Making Neighborhood-Disadvantage Metrics Accessible — The Neighborhood Atlas


                Author and article information

                BMC Public Health
                BMC Public Health
                BMC Public Health
                BioMed Central (London )
                14 June 2021
                14 June 2021
                : 21
                [1 ]GRID grid.21107.35, ISNI 0000 0001 2171 9311, Department of Health Policy & Management, , Johns Hopkins Bloomberg School of Public Health, ; Baltimore, Maryland USA
                [2 ]GRID grid.21107.35, ISNI 0000 0001 2171 9311, Center for Drug Safety and Effectiveness, , Johns Hopkins University, ; Baltimore, Maryland USA
                [3 ]GRID grid.21107.35, ISNI 0000 0001 2171 9311, Center for Population Health Information Technology, , Johns Hopkins University, ; Baltimore, Maryland USA
                [4 ]GRID grid.38142.3c, ISNI 000000041936754X, Department of Epidemiology, , Harvard T.H. Chan School of Public Health, ; Boston, Massachusetts USA
                [5 ]GRID grid.21107.35, ISNI 0000 0001 2171 9311, Division of Health Sciences Informatics, , Johns Hopkins School of Medicine, ; Baltimore, Maryland USA
                © The Author(s) 2021

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                Research Article
                Custom metadata
                © The Author(s) 2021

                Public health
                covid-19 policy,covid-19 prevalence,area deprivation index,social determinants of health,social distancing index,comparative interrupted time-series analysis,stay-at-home order


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