• Usama Bilal, Loni P Tabb, Sharrelle Barber, and Ana V Diez Roux.
• Drexel Dornsife School of Public Health, Philadelphia, Pennsylvania (U.B., L.P.T., S.B., A.V.D.).
• Ann. Intern. Med. 2021 Jul 1; 174 (7): 936944936-944.

BackgroundPreliminary evidence has shown inequities in coronavirus disease 2019 (COVID-19)-related cases and deaths in the United States.ObjectiveTo explore the emergence of spatial inequities in COVID-19 testing, positivity, confirmed cases, and mortality in New York, Philadelphia, and Chicago during the first 6 months of the pandemic.DesignEcological, observational study at the ZIP code tabulation area (ZCTA) level from March to September 2020.SettingChicago, New York, and Philadelphia.ParticipantsAll populated ZCTAs in the 3 cities.MeasurementsOutcomes were ZCTA-level COVID-19 testing, positivity, confirmed cases, and mortality cumulatively through the end of September 2020. Predictors were the Centers for Disease Control and Prevention Social Vulnerability Index and its 4 domains, obtained from the 2014-2018 American Community Survey. The spatial autocorrelation of COVID-19 outcomes was examined by using global and local Moran I statistics, and estimated associations were examined by using spatial conditional autoregressive negative binomial models.ResultsSpatial clusters of high and low positivity, confirmed cases, and mortality were found, co-located with clusters of low and high social vulnerability in the 3 cities. Evidence was also found for spatial inequities in testing, positivity, confirmed cases, and mortality. Specifically, neighborhoods with higher social vulnerability had lower testing rates and higher positivity ratios, confirmed case rates, and mortality rates.LimitationsThe ZCTAs are imperfect and heterogeneous geographic units of analysis. Surveillance data were used, which may be incomplete.ConclusionSpatial inequities exist in COVID-19 testing, positivity, confirmed cases, and mortality in 3 large U.S. cities.Primary Funding SourceNational Institutes of Health.

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