• Yiqing Xia, Huiting Ma, Gary Moloney, Héctor A Velásquez García, Monica Sirski, Naveed Z Janjua, David Vickers, Tyler Williamson, Alan Katz, Kristy Yiu, Rafal Kustra, David L Buckeridge, Marc Brisson, Stefan D Baral, Sharmistha Mishra, and Mathieu Maheu-Giroux.
• Department of Epidemiology and Biostatistics (Xia, Buckeridge, Maheu-Giroux), School of Population and Global Health, McGill University, Montréal, Que.; MAP Centre for Urban Health Solutions (Xia, Ma, Moloney, Yiu, Mishra), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; School of Population and Public Health (Velásquez García, Janjua), University of British Columbia; British Columbia Centre for Disease Control (Velásquez García, Janjua), Vancouver, BC; Departments of Community Health Sciences and Family Medicine (Sirski, Katz), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Community Health Sciences (Vickers, Williamson) and Centre for Health Informatics (Williamson), University of Calgary, Calgary, Alta.; Dalla Lana School of Public Health (Kustra), University of Toronto, Toronto, Ont.; Département de médecine sociale et préventive (Brisson), Faculté de médecine, Université Laval, Québec, Que.; Department of Epidemiology (Baral), Johns Hopkins School of Public Health, Baltimore, Md.; Division of Infectious Diseases (Mishra), Department of Medicine, University of Toronto, Toronto, Ont.
• CMAJ. 2022 Feb 14; 194 (6): E195-E204.

BackgroundUnderstanding inequalities in SARS-CoV-2 transmission associated with the social determinants of health could help the development of effective mitigation strategies that are responsive to local transmission dynamics. This study aims to quantify social determinants of geographic concentration of SARS-CoV-2 cases across 16 census metropolitan areas (hereafter, cities) in 4 Canadian provinces, British Columbia, Manitoba, Ontario and Quebec.MethodsWe used surveillance data on confirmed SARS-CoV-2 cases and census data for social determinants at the level of the dissemination area (DA). We calculated Gini coefficients to determine the overall geographic heterogeneity of confirmed cases of SARS-CoV-2 in each city, and calculated Gini covariance coefficients to determine each city's heterogeneity by each social determinant (income, education, housing density and proportions of visible minorities, recent immigrants and essential workers). We visualized heterogeneity using Lorenz (concentration) curves.ResultsWe observed geographic concentration of SARS-CoV-2 cases in cities, as half of the cumulative cases were concentrated in DAs containing 21%-35% of their population, with the greatest geographic heterogeneity in Ontario cities (Gini coefficients 0.32-0.47), followed by British Columbia (0.23-0.36), Manitoba (0.32) and Quebec (0.28-0.37). Cases were disproportionately concentrated in areas with lower income and educational attainment, and in areas with a higher proportion of visible minorities, recent immigrants, high-density housing and essential workers. Although a consistent feature across cities was concentration by the proportion of visible minorities, the magnitude of concentration by social determinant varied across cities.InterpretationGeographic concentration of SARS-CoV-2 cases was observed in all of the included cities, but the pattern by social determinants varied. Geographically prioritized allocation of resources and services should be tailored to the local drivers of inequalities in transmission in response to the resurgence of SARS-CoV-2.© 2022 CMA Impact Inc. or its licensors.

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