COVID-19 Pandemic
Wealth Accumulation, State Borders, and COVID-19: A Novel Exploration of COVID-19 Prevalence in Kansas City, Dec 2020 – Dec 2021 Victoria Fisher* Victoria Fisher Allison Boretsky Aveline Roderick Nadia Abuelezam
Background: Historical policies and structures within the United States have cultivated the political economy and socio-spatial demographics of today, largely informing health outcome disparities. It can be difficult to tease apart the impact of history from the influence of current policies. This novel exploration of Kansas City, Kansas (KS) and Missouri (MO) aims to understand how historical policy-resultant wealth concentration and accumulation and state-level COVID-19 responses are associated with COVID-19 prevalence.
Methods: COVID-19 data for December 2020 through December 2021 were sourced from the CDC. 2021 demographics were taken from the American Community 5-Year Survey. We conducted a linear mixed effect regression model to examine the state effect on prevalence outcomes. The main outcome was the log of COVID-19 prevalence per 10,000. The main predictor was state. Covariates included measures of affluence (percent of families with income greater than $125,000, percent employed professionally, and percent with a bachelor’s degree or higher), age, and an interaction term between time and state.
Findings: For 2021, the average ZIP code COVID-19 prevalence per 100,000 person months was 4093 (95% CI: 3953, 4240). In the unadjusted model, MO had nearly 18% (95 CI: -1%, 40%) greater prevalence than KS. After controlling for affluence, the state effect was insignificant (8%, 95 CI: -10%, 27%). Affluence was significantly associated with 14% (95% CI: -21%, -5.8%) less COVID-19 prevalence; increasing age was associated with an 11% (95% CI: -22%, 1%) decrease in COVID-19 prevalence.
Discussion: Affluence and older age were strong predictors of lower COVID-19 prevalence across Kansas City ZIP codes, suggesting that historical policies that influenced wealth and resources have strong protective benefits. Affluence and age do not account for the total difference between KS and MO COVID-19 outcomes suggesting that COVID-19 policy differences were also impactful.