abstract: 'Background: Disproportionate risks of COVID-19 in congregate care

  facilities including long-term care homes, retirement homes, and

  shelters both affect and are affected by SARS-CoV-2 infections among

  facility staff. In cities across Canada, there has been a consistent

  trend of geographic clustering of COVID-19 cases. However, there is

  limited information on how COVID-19 among facility staff reflects urban

  neighborhood disparities, particularly when stratified by the social and

  structural determinants of community-level transmission. Objective: This

  study aimed to compare the concentration of cumulative cases by

  geography and social and structural determinants across 3 mutually

  exclusive subgroups in the Greater Toronto Area (population: 7.1

  million): community, facility staff, and health care workers (HCWs) in

  other settings.Methods: We conducted a retrospective, observational

  study using surveillance data on laboratory-confirmed COVID-19 cases

  (January 23 to December 13, 2020; prior to vaccination rollout). We

  derived neighborhood-level social and structural determinants from

  census data and generated Lorenz curves, Gini coefficients, and the

  Hoover index to visualize and quantify inequalities in cases.Results:

  The hardest-hit neighborhoods (comprising 20\% of the population)

  accounted for 53.87\% (44,937/83,419) of community cases, 48.59\%

  (2356/4849) of facility staff cases, and 42.34\% (1669/3942) of other

  HCW cases. Compared with other HCWs, cases among facility staff

  reflected the distribution of community cases more closely. Cases among

  facility staff reflected greater social and structural inequalities

  (larger Gini coefficients) than those of other HCWs across all

  determinants. Facility staff cases were also more likely than community

  cases to be concentrated in lower-income neighborhoods (Gini 0.24, 95\%

  CI 0.15-0.38 vs 0.14, 95\% CI 0.08-0.21) with a higher household density

  (Gini 0.23, 95\% CI 0.17-0.29 vs 0.17, 95\% CI 0.12-0.22) and with a

  greater proportion working in other essential services (Gini 0.29, 95\%

  CI 0.21-0.40 vs 0.22, 95\% CI 0.17-0.28).Conclusions: COVID-19 cases

  among facility staff largely reflect neighborhood-level heterogeneity

  and disparities, even more so than cases among other HCWs. The findings

  signal the importance of interventions prioritized and tailored to the

  home geographies of facility staff in addition to workplace measures,

  including prioritization and reach of vaccination at home (neighborhood

  level) and at work.'
affiliation: 'Mishra, S (Corresponding Author), Univ Toronto, Dept Med, Div Infect
  Dis, Toronto, ON, Canada.

  Mishra, S (Corresponding Author), Univ Toronto, Dalla Lana Sch Publ Hlth, Toronto,
  ON, Canada.

  Mishra, S (Corresponding Author), St Michaels Hosp, Unity Hlth Toronto, Room 315,209
  Victoria St, Toronto, ON M5B 1T8, Canada.

  Ma, Huiting; Yiu, Kristy C. Y.; Fahim, Christine; Moloney, Gary; Darvin, Dariya;
  Landsman, David; Straus, Sharon; Mishra, Sharmistha, St Michaels Hosp, Unity Hlth
  Toronto, Toronto, ON, Canada.

  Baral, Stefan D., Johns Hopkins Sch Publ Hlth, Dept Epidemiol, Baltimore, MD USA.

  Chan, Adrienne K.; Mishra, Sharmistha, Univ Toronto, Dept Med, Div Infect Dis, Toronto,
  ON, Canada.

  Chan, Adrienne K.; Mishra, Sharmistha, Univ Toronto, Dalla Lana Sch Publ Hlth, Toronto,
  ON, Canada.

  Chan, Adrienne K., Univ Toronto, Div Infect Dis, Sunnybrook Hlth Sci, Toronto, ON,
  Canada.

  Chan, Adrienne K.; Mishra, Sharmistha, Univ Toronto, Inst Hlth Policy Management
  \& Evaluat, Toronto, ON, Canada.

  Straus, Sharon, Univ Toronto, Dept Med, Toronto, ON, Canada.

  Mishra, Sharmistha, St Michaels Hosp, Unity Hlth Toronto, Room 315,209 Victoria
  St, Toronto, ON M5B 1T8, Canada.'
article-number: e34927
author: Ma, Huiting and Yiu, Kristy C. Y. and Baral, Stefan D. and Fahim, Christine
  and Moloney, Gary and Darvin, Dariya and Landsman, David and Chan, Adrienne K. and
  Straus, Sharon and Mishra, Sharmistha
author-email: sharmistha.mishra@utoronto.ca
author_list:
- family: Ma
  given: Huiting
- family: Yiu
  given: Kristy C. Y.
- family: Baral
  given: Stefan D.
- family: Fahim
  given: Christine
- family: Moloney
  given: Gary
- family: Darvin
  given: Dariya
- family: Landsman
  given: David
- family: Chan
  given: Adrienne K.
- family: Straus
  given: Sharon
- family: Mishra
  given: Sharmistha
da: '2023-09-28'
doi: 10.2196/34927
files: []
issn: 2369-2960
journal: JMIR PUBLIC HEALTH AND SURVEILLANCE
keywords: 'long-term care; nursing home; staff; essential worker; retirement home;

  shelter; congregate living; COVID-19; observational; risk; transmission;

  elderly; older adults; retirement; nurse; health care worker;

  congregate; trend; geography; Canada; Toronto'
keywords-plus: TRANSMISSION; SARS-COV-2; CANADA; HEALTH; INDEX; HOMES
language: English
month: OCT
number: '10'
number-of-cited-references: '46'
orcid-numbers: 'Yiu, Kristy/0000-0002-7378-9773

  Mishra, Sharmistha/0000-0001-8492-5470

  Ma, Huiting/0000-0003-1910-5614'
papis_id: c6d18de5acac86572d58b0f5a1dd89fc
ref: Ma2022covid19cases
times-cited: '1'
title: 'COVID-19 Cases Among Congregate Care Facility Staff by Neighborhood of Residence
  and Social and Structural Determinants: Observational Study'
type: article
unique-id: WOS:000867515600003
usage-count-last-180-days: '1'
usage-count-since-2013: '2'
volume: '8'
web-of-science-categories: Public, Environmental \& Occupational Health
year: '2022'