Introduction of Covid 19 and Contextual Analysis

Covid-19 has forced many families and businesses to put their everyday practices on hold. Even with many restrictions being lifted and a sense of normalcy finally befalling society, the coming winter season estimates another COVID surge underway. All around California, rates are steadily increasing with L.A. County figures rising to a level where indoor masks might be mandated again (Kawahara et al., 2022). A recent CDC report found that 41.6% of adults have SARS-CoV-2 anti-N antibodies which are often correlated to the previous infection. However, the concern is that out of the 655 participants with anti-S-positive and anti-N-positive results self-reported that they never experienced COVID-19 (Akinbami et al., 2022). Even though these are based on self-reported data, the concern for asymptomatic spreading resulting in additional cases is a public health concern. With the declining administering of the bi-valent booster, with only 7% of 209 million eligible individuals receiving their dosage, concern for future preparedness is being acknowledged (Vaziri, 2022).

Case Study of Covid-19 Cases concerning Health & Disadvantaged Communities

For the current study, Covid-19 cases were compared to two variables…

  1. Reported Cardiovascular Cases
  2. Disadvantaged Communities (Poverty %, Median Household Income (MHI), etc.)

Both of these variables were the focus of the spatial study. These were chosen due to Covid-19 being a virus that has mainly targeted a human’s cardiovascular system as well as the overlay of poverty indexes to see if there is a possible correlation. The goal is to figure out if Covid-19 cases and their associated health concerns have a distinct spatial correlation with disadvantaged communities.

People with primary Covid-19 hospitalizations were found to experience an increased risk for venous thromboembolism (VTE) heart failure, and stroke with secondary cardiovascular risks showing similar increases as well (Raisi-Estabragh et al., 2022). The increase in the number of diseases and mortality outcomes poses significant health problems even after returning to healthy levels. Another study conducted found that acute COVID-19 individuals that didn’t require hospitalization also showed increased cardiovascular diseases such as ischemic and non-ischemic heart disease (Xie et al., 2022). Long-term care and monitoring for these factors aren’t always plausible for people with busy schedules as well as being cost-efficient.

The second selection of income and poverty are also chosen for this study. These are based on qualities found in disadvantaged communities. According to the California Public Utilities Commission, disadvantaged communities include economic, health, and environmental burdens (poverty, unemployment, etc.) (CPUC, 2021). Past research has also compared income and race with Covid-19 mortality rates. One study was based on income gradient contributions to Covid-19 rates and morbidity. It was based in Mexico and some of the findings found probabilities for hospitalization to be four times higher in lower-income families versus richer individuals (Arceo-Gomez et al., 2021). However, the difference between dying while being categorized as a rich or poor individual was equal to being a person who is immunosuppressed or twice the chances of having diabetes which is prevalent in the current population. This brings into question the correlation between selected variables and wide-scale generalization.

Covid Cases in California

Under these two conditions, the deployment of these factors was conducted through geospatial analysis. Utilizing CalEnviroScreen, census tract data, and Covid-19 case data in the US, analysis of these conditions on top of each other allowed spatial comparison of these variables. Some additional layers such as Disadvantaged communities as well as Tiger/Line shapefiles allowed county borders as well as applicable MHI values to be included in the mapping process.

Figure 1. California Covid Cases by County

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Figure 1. Offers a map of all the counties in California. The important layer to note is the Confirmed Covid Cases per county.

From the dataset, LA county has experienced the highest number of Covid cases ranging from 3,000,000 to 4,000,000 cases. San Diego comes in second with the other counties showing similar results to each other. Two other variables are included that utilize the CalEnviroScreen. The total population of 2019 as well as the MHI of 2020 are included in Figure 1. This enables comparison of census tract data available for population demographics and MHI which are of the key variables of interest. LA county’s census tracts range from 10,000 people. It does have some tracts in the 10,000 to 30,000 range but the density of tracts in the LA area can help explain the number of cases prevalent in the area. Interestingly, the Bay Area which is also heavily populated didn’t experience the same number of Covid cases which was around 1,000,000 confirmed cases.

Figure 2. Covid-19 Deaths in Specific Counties

Figure 2. Analyzes the top six specific county vs. Covid-19 deaths.

LA county tops the charts setting the number of deaths relating to the number of confirmed cases equalling >30,000. The rest of the datasets are around each other with the second and third highest confirmed Covid-19 deaths existing in the San Bernardino and Orange counties (7571 & 8133). The spatial distribution shows that a deeper focus on LA county can be interesting due to the pure number of confirmed cases and its vast difference of Covid-19 related deaths in comparison to other counties. Figure 3. utilizes the CalEnviroScreen variable of “Cardiovas” to build upon the relation of Covid-19 and its effect on the cardiovascular system and people that already experience these complications. Since specific locations aren’t listed for Covid-19 cases, we can utilize cardiovascular data as another medium for health concerns. Nearby healthcare facility locations are also included with a buffer of 10 km due to a study conducted by Nicholl and colleagues that examined straight-line ambulance journey distances versus increased risk of death. They concluded that a “10 km increase in straight-line distance can be associated with a 1% increase in mortality” (Nicholl et al., 2007). The minimal distance for the best chances of receiving proper medical care was included in this buffer zone which was joined with the census tract zones that intersected with these healthcare facilities

Figure 3. Cardiovascular Spatial Data vs. Health Care Facilities (10 km buffer)

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Figure 3. Includes the type of healthcare facility which is intersected with the Cardiovas layer.

Cardiovascular rates seem to be pretty proficient in these census tracts with a concerning case count of 27.5 to 28. Fortunately, there are health facilities in the 10 km buffer zone. However, not all the facilities deal with Covid-19 related symptoms and cases. Casual clinics do exist but can’t effectively handle extreme cases of Covid-19. The hospitals are located in the southernmost census tracts. This means that people with severe cases requiring hospitalization would need to travel farther than the 10 km distance which can effectively hurt their chances of receiving immediate care.

Figure 4. Poverty and MHI Index for Concerned Tracts

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Figure 4. Poverty percentage and MHI datasets overlaid over census tracts of interest.

The last map shown takes a look at Disadvantaged Communities variables of Median Household income and Poverty %. Shifting through the two layers, the data shows that these areas are in zones with a high poverty percentage with most tracts existing in the 90-100 percent range. Turning on the Disadvantaged Communities layer to gain access to the Median Household Income, we can see that most of these tracts reside in the $40,000-$10,000 range. It is interesting to see that the census tracts that exhibit a higher Poverty % are also part of the lower median household income tracts. Based on federal poverty guidelines by the Department of Health and Human Services, guidelines can range from the number of people in a household. For a family of two, this can be in the $17,420 range (ASPE, 2021). The current spatial analysis study on Covid-19 cardiovascular cases with disadvantaged community dynamics doesn’t look at individual household numbers which could present future research. However, the Poverty % index as well as the Median Household Income layers does show a correlation between higher ranges of poverty to lower median household incomes.

Conclusions and Recommendations

The data shows trends toward a possible correlation between MHI, poverty percentage, and cardiovascular cases. However, it’s key to note that these shouldn’t be taken at face value. Covid-19 cases do have a correlation to increased cardiovascular complications but utilizing our cardiovascular dataset, it’s not purely based on Covid-19 cases. Individuals can experience these problems from historical and other factors such as air pollution. The spatial aspect of this study does provide a sensible geographical sense of the reported cardiovascular diseases and the association based on variables associated with disadvantaged communities. For future exploration, assisted understanding of other factors such as PM2.5 and 10 concentrations could be included. The code and datasets provided at the end of this report can easily select these variables in the CalEnviroScreen dataset as well looking at other California counties. Potential policy could be enacted for these specific census tracts that face these problems. Underlying public health concerns specific to these areas could prove fruitful. Covid-19 has highlighted the imbalance between these disadvantaged communities and decently funded families. Environmental justice factors should be addressed to figure out the real issues plaguing these communities and to hopefully bring their standards of living and health care to a higher standard.

#Link to Rscript Omoto_FP.R

Resources

2021 poverty guidelines. ASPE. (2021). Retrieved December 2022, from https://aspe.hhs.gov/topics/poverty-economic-mobility/poverty-guidelines/prior-hhs-poverty-guidelines-federal-register-references/2021-poverty-guidelines

Akinbami, L. J., Kruszon-moran, D., Wang, C.-Y., Storandt, R. J., Clark, J., Riddles, M. K., & Mohadjer, L. K. (2022, December 1). SARS-COV-2 serology and self-reported infection among adults - National Health and Nutrition Examination Survey, United States, August 2021–May 2022. Centers for Disease Control and Prevention. Retrieved December 2022, from https://www.cdc.gov/mmwr/volumes/71/wr/mm7148a4.htm

Arceo-Gomez, E. O., Campos-Vasquez, R. M., Esquivel, G., Alcaraz, E., Martinez, L. A., & Lopez, N. G. (2021, November 10). The income gradient in covid-19 mortality and hospitalisation: An … The Lancet Regional Health Americas. Retrieved December 2022, from https://www.thelancet.com/journals/lanam/article/PIIS2667-193X(21)00111-3/fulltext

CA.gov. (2022, December). CalEnviroScreen 4.0. Oehha.ca.gov. Retrieved December 2022, from https://oehha.ca.gov/calenviroscreen

Covid-19 cases us. COVID-19 Resources. (n.d.). Retrieved December 2022, from https://coronavirus-resources.esri.com/datasets/628578697fb24d8ea4c32fa0c5ae1843_0/explore?location=36.271835%2C-119.075881%2C6.94

Disadvantaged communities. California Public Utilities Commission. (2021). Retrieved December 2022, from https://www.cpuc.ca.gov/industries-and-topics/electrical-energy/infrastructure/disadvantaged-communities

I16 Census tract disadvantagedcommunities 2020. California State Geoportal. (n.d.). Retrieved December 2022, from https://gis.data.ca.gov/datasets/2826deb491014208bcfd59b4f4473f6f_0/about

Kawahara, M., & Vaziri, A. (2022, December 2). Covid in California: 42% of U.S. adults infected but nearly half didn’t know it. San Francisco Chronicle. Retrieved December 2022, from https://www.sfchronicle.com/health/article/COVID-in-California-live-updates-17624808.php

Nicholl, J., West, J., Goodacre, S., & Turner, J. (2007, September 24). The relationship between distance to hospital and patient mortality in emergencies: An observational study. Emergency medicine journal : EMJ. Retrieved December 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2464671/

OSHPD Healthcare Facilities. California State Geoportal. (n.d.). Retrieved December 2022, from https://gis.data.ca.gov/datasets/3f0036c60fa04c9ea50251ba92913db8_0/explore?location=37.168398%2C-119.327211%2C7.02

Raisi-Estabragh, Z., Cooper, J., Salih, A., Raman, B., Lee, A. M., Neubauer, S., Harvey, N. C., & Petersen, S. E. (2022, September 21). Cardiovascular disease and mortality sequelae of COVID-19 in the UK Biobank. Heart. Retrieved December 2022, from https://heart.bmj.com/content/early/2022/09/21/heartjnl-2022-321492

Responsible Party Unknown. (2021, October 12). Tiger/line shapefile, 2019, State, California, current Census Tract State-based. Catalog. Retrieved December 2022, from https://catalog.data.gov/dataset/tiger-line-shapefile-2019-state-california-current-census-tract-state-based

Vaziri, A. (2022, October 18). Covid booster uptake ‘slow and sluggish’ in Bay Area. GovTech. Retrieved December 2022, from https://www.govtech.com/em/safety/covid-booster-uptake-slow-and-sluggish-in-bay-area

Xie, Y., Xu, E., Bowe, B., & Al-Aly, Z. (2022, February 7). Long-term cardiovascular outcomes of COVID-19. Nature News. Retrieved December 2022, from https://www.nature.com/articles/s41591-022-01689-3