Socioeconomic, geographic and demographic factors have played a critical role in COVID-19 mortality rates in Orange County, according to a UC Irvine study published Thursday.

The study was published in Emerging Infectious Diseases, which shows some demographic groups were more likely to test positive and die from the virus, and that risk factors for infection shifted over time.

“At the beginning of the pandemic, in March 2020, cases were clustered in the more affluent coastal areas of the county but then shifted to north-central locations, particularly in the cities of Santa Ana and Anaheim,” said UCI assistant professor of public health and the study’s corresponding author, Daniel Parker. “We examined how contextual factors — such as levels of education, insurance and income — can lead to increased risk of infection or death.”

The Orange County Health Care Agency provided testing and mortality data from March 1 to Aug. 16, 2020, while UCI and OCHCA used 11 drive-through sites to collect data on seroprevalence — the level of a pathogen in a population, as measured in blood serum.

Researchers analyzed age, race, gender, income, education, insurance coverage and household density per ZIP code.

— Seniors, males and Hispanic or Latino individuals were more likely to be diagnosed with the virus;

— Asians were more likely to die than non-Hispanic whites;

— Hispanic and Latino individuals had 1.7 times the odds of testing positive for infection than non-Hispanic whites;

— Residents with lower incomes were more likely to test positive for COVID-19;

— People from ZIP codes with higher household density, less education and less insurance coverage were more likely to be infected and die.

“Our local Asian population is extremely diverse, and lumping them into a single category probably masks some important differences in risk of infection or death between different Asian populations,” said Parker.

“A pandemic is really made up of many local epidemics — each playing out according to local contextual factors,” added Parker. “The way COVID-19 has rolled through Orange County is different from the way it’s currently burning through Myanmar, for example. It’s important to understand and document local contextual factors associated with infectious disease outbreaks and the resulting disparities in morbidity, mortality and quality of life.”

The UCI study concluded that reasons for the patterns of disparity within the county are “likely complex and related to issues of accessing health care and general social determinants of health.” The study recommended developing socioculturally appropriate approaches emphasizing equity, and working with community-based organizations to ensure access to health services.

The research team included Bernadette Boden-Albala, Tim Bruckner, Veronica Vieira and Schott Bartell of UCI’s Program in Public Health; Philip Felgner of UCI’s School of Medicine; Vladimir Minin and Catalina Medina of UCI’s Donald Bren School of Information and Computer Sciences; and Dr. Matthew Zahn, medical director of the Communicable Disease Control Division, and senior epidemiologist Alissa Dratch of the Orange County Health Care Agency.

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