Social epidemiology of urban COVID-19 inequities in the Americas

Keywords: Health inequity, COVID-19, Urban health, Americas, Ecosocial theory, Socioeconomic status
Abstract Type: Paper Abstract

Abstract

The COVID-19 pandemic has spread through pre-existing fault lines in societies, exposing deeply ingrained health inequities in countries and cities throughout the world. Although cities are generally wealthier than rural areas, the wide disparities in socioeconomic status and segregation into wealthy and poor neighborhoods means that many large cities contain a microcosm of social gradients – and inequities in health – present in the rest of the country. Latin America is the most urbanized region in the world with over 80% of its inhabitants living in cities, and similarly, over 70% of Canadians live in census metropolitan areas. In many cities of the Global South, urban informal settlements have been identified as being at elevated risk of COVID-19 due to poverty, violence, and overcrowding. This study presents detailed social epidemiological profiles of urban COVID-19 inequities in eight of the largest metropolitan areas in Latin America and Canada – São Paulo, Mexico City, Buenos Aires, Rio de Janeiro, Bogotá, Lima, Santiago, and Toronto. We calculate weekly population-adjusted incidence and test positivity rates and measure absolute and relative inequalities in the distribution of COVID-19 over the first two years of the pandemic using district-level median household income. Using an ecosocial theoretical approach, we probe the complex, multi-pathway, cumulative mechanisms through which determinants of COVID-19 inequities interact with socioeconomic status, life-course, and urban vulnerability to produce robust profiles of urban COVID-19 epidemics in the Americas.