Neighbourhood-level Racial/Ethnic and Economic Inequities in COVID-19 Burden Within Urban Areas in the US and Canada

The COVID-19 pandemic exhibits stark social inequities in infection and mortality outcomes. We investigated neighborhood-level inequities across cities in the US and Canada for COVID-19 cumulative case rates (46 cities), death rates (12 cities), testing rates and test positivity (12 cities), using measures that characterize social gradients by race/ethnicity, socioeconomic composition, or both jointly. We found consistent evidence of social gradients for case, death and positivity rates, with the most privileged neighborhoods having the lowest rates, but no meaningful variation in the magnitude of inequities between cities. Gradients were not apparent in testing rates, suggesting inadequate testing in the most deprived neighborhoods. Health agencies should monitor and compare inequities as part of their COVID-19 reporting practices and to guide pandemic response efforts. HIGHLIGHTSO_LIWithin urban regions with available data in the US and Canada, there were strong social gradients for case, death and positivity rates C_LIO_LIThe most racially and/or economically privileged neighborhoods had the lowest rates C_LIO_LISocial gradients were similar for neighborhood-level measures of racial/ethnic composition, income, racialized economic segregation, and racialized occupational segregation C_LIO_LITesting rates did not show consistent social gradients, which suggests that the most deprived neighborhoods have inadequate access to testing relative to their higher disease burden C_LI