Analyzing Spatial-Temporal Impacts of Neighborhood Socioeconomic Status Variables on COVID-19 Outbreaks as Potential Social Determinants of Health

The COVID-19 pandemic is not only a medical disease outbreak but also a social inequality and health disparity problem. This study analyzed dynamic temporal and spatial associations between confirmed COVID-19 cases and socioeconomic status (SES) variables at the neighborhood level with three case studies to (1) analyze five temporal stages in the County of San Diego, California; (2) compare six U.S. metropolitan areas; and (3) compare SES associations across two spatial scales (counties and zip code units). We identified eleven SES variables as potential contributors to the social determinants of health that influence COVID-19 outbreaks and showed how their correlation coefficients vary over five phases. We found that changes in COVID-19 hot spots and clusters are minimal across the five stages. The consistent spatial patterns through the five outbreak periods imply that the place effects associated with fundamental health disparity factors are persistent and not easily changed. The impact of COVID-19 on SES varies in different local contexts. We also found that Hispanic populations, uninsured groups, Spanish-speaking families, those with less than a ninth-grade education level, and high household densities strongly correlated with COVID-19 cases in all six metropolitan areas. We did not find high scale dependency in SES association patterns between county and zip code spatial units, but analysis at a finer level can provide more association patterns.