By the end of 2022, our collective thinking shifted from avoiding individual exposure and infection to realising no single individual was immune to the societal and economic consequences of the pandemic. While many of us can detail the enduring effects of the COVID-19 pandemic in our personal lives, there remain unanswered questions about these effects at the population level. How do we understand the population-level trends? Where do we look? And, perhaps most importantly, what do we do with this information?
Studying neighbourhoods may be a valuable way to address these questions. Neighbourhoods are a primary focal point of our lives, providing us access to necessary life-saving resources, like healthy food, spaces to exercise, healthcare facilities, employment opportunities, and social networks. Therefore, it is reasonable to consider the spread of and recovery from infectious diseases and the post-epidemic consequences in the context of neighbourhoods.
There is no single story explaining how and why COVID-19 was spread across neighbourhoods within states in the U.S. Rather, it is a nuanced story of the intersections of state- and local-social and policy environments.
Grace A. Noppert & Sonia T. Hegde
Neighbourhood-level disparities in COVID-19 impact across U.S. states
Our research utilises COVID-19 surveillance data mandated for collection by U.S. state health departments from 2020 to 2022. This dataset primarily includes summary counts of COVID-19 cases, reported either by postal ZIP code or census tract—political boundaries set by the U.S. government that are commonly used to define neighbourhoods. We integrated these case counts with data on various neighbourhood characteristics, such as socioeconomic status, population density, political affiliations, and whether the area is urban or rural.
Using these combined data, we addressed two key questions: Did COVID-19 impact all neighbourhoods similarly, with individuals across a state experiencing the same level of burden? and are there differences in neighbourhood-level trends across different states?
Credit. Communications medicine
Our findings reveal that in some states, like Wisconsin and Delaware, the distribution of COVID-19 cases across neighbourhoods was relatively uniform. Despite high median case counts per 10,000 people (3,078 in Wisconsin and 3,071 in Delaware), neighbourhoods across these states—whether centrally located or near the borders—experienced similar case counts.
However, in other states, we observed significant disparities in how COVID-19 impacted neighbourhoods. For instance, Maine and Vermont exhibited notable heterogeneity, with certain neighbourhoods bearing a disproportionate share of the COVID-19 burden. These findings highlight inequities in how the pandemic affected different communities within these states.
Neighbourhood factors and local environments shaped the spread of COVID-19 across U.S. states
We sought to determine whether subtle neighbourhood characteristics could help explain the varying COVID-19 burdens observed across neighbourhoods. We examined factors such as neighbourhood socioeconomic status, population density, political leanings, and whether an area was rural or urban.
Our findings revealed that the influence of these neighbourhood characteristics on COVID-19 distribution varied by state. In some states, there was a strong correlation between higher levels of social disadvantage and a greater COVID-19 burden—indicating that more disadvantaged neighbourhoods were disproportionately affected. However, this pattern was not consistent across all states.
In certain states, we observed a positive correlation between higher proportions of republican votes in county-level elections (both Senate and Presidential races from 2012-2018) and elevated COVID-19 case burdens. Again, this was not a universal trend across all states.
As researchers, we often seek overarching explanations, but in this case, there is no single narrative to explain how and why COVID-19 spread across neighbourhoods. Instead, the story is far more complex, shaped by the unique intersections of state- and local-level social and policy environments.
Neighbourhood vulnerability and resilience in the wake of COVID-19 and future epidemics
Viewing the COVID-19 pandemic through the lens of neighbourhoods reveals two key insights. First, the uneven spread of COVID-19 suggests that recovery will also be uneven. While some communities may regain aspects of their well-being—economic, social, and health—others may struggle. Severe population losses, business closures, and economic downturns in certain neighbourhoods make full recovery unlikely.
These findings have broader implications. As future epidemics loom, we must ask: Does a neighbourhood’s vulnerability from COVID-19 increase its susceptibility to the next epidemic? Will diseases like influenza and RSV further erode these already impacted communities? What can we learn from resilient neighbourhoods?
Hopefully, these findings can help target recovery resources to communities most at risk. As we shape public health policies, it’s crucial to consider the interaction between state and local policies, neighbourhood environments, and unique local factors. The pandemic’s lasting impact highlights growing inequities in the U.S., underscoring the need for tailored, neighbourhood-focused public health strategies moving forward.
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Journal reference
Noppert, G. A., Clarke, P., Hoover, A., Kubale, J., Melendez, R., Duchowny, K., & Hegde, S. T. (2024). State variation in neighborhood COVID-19 burden across the United States. Communications Medicine, 4(1), 36. https://doi.org/10.1038/s43856-024-00459-1
