Association of poor housing conditions with COVID-19 incidence and mortality across US counties

作者：Khansa Ahmad, Sebhat Erqou, Nishant R. Shah, Umair Nazir, Alan Morrison, Gaurav Choudhary, Wen-Chih Wu · 发表于：PLoS ONE · 年份：2020 · DOI：10.1371/journal.pone.0241327 · 被引用次数：317 · 研究领域：COVID-19 epidemiological studies、Health disparities and outcomes、Homelessness and Social Issues

OBJECTIVE: Poor housing conditions have been linked with worse health outcomes and infectious disease spread. Since the relationship of poor housing conditions with incidence and mortality of COVID-19 is unknown, we investigated the association between poor housing condition and COVID-19 incidence and mortality in US counties. METHODS: We conducted cross-sectional analysis of county-level data from the US Centers for Disease Control, US Census Bureau and John Hopkins Coronavirus Resource Center for 3135 US counties. The exposure of interest was percentage of households with poor housing conditions (one or greater of: overcrowding, high housing cost, incomplete kitchen facilities, or incomplete plumbing facilities). Outcomes were incidence rate ratios (IRR) and mortality rate ratios (MRR) of COVID-19 across US counties through 4/21/2020. Multilevel generalized linear modeling (with total population of each county as a denominator) was utilized to estimate relative risk of incidence and mortality related to poor housing conditions with adjustment for population density and county characteristics including demographics, income, education, prevalence of medical comorbidities, access to healthcare insurance and emergency rooms, and state-level COVID-19 test density. We report incidence rate ratios (IRRs) and mortality ratios (MRRs) for a 5% increase in prevalence in households with poor housing conditions. RESULTS: Across 3135 US counties, the mean percentage of households with po...