Per the results of our analysis, household overcrowding is a significant risk factor for COVID-19 mortality. Importantly, the results of our study revealed that in LA County, household overcrowding was an even stronger predictor of increased mortality rates than the total number of COVID-19 cases. Additionally, our findings emphasize that elderly citizens residing in overcrowded households are at a particularly increased risk of mortality from COVID-19.
These findings suggest key implications for addressing the COVID-19 pandemic and future outbreaks of communicable disease. These findings are consistent with studies investigating COVID-19 transmissibility which found transmission to be greater in indoor congregate settings, such as jails and buses . These settings share similar characteristics with overcrowded housing, including prolonged time spent with the same group of individuals, minimal ventilation, and multiple individuals occupying a limited space. While age, level of income, ethnic background, and medical co-morbidities have been frequently described as risk factors for poor outcomes associated with COVID-19 infection , our analyses suggest that public health measures designed to reduce mortality among persons with COVID-19 ought to make special consideration of persons living in overcrowded housing. The Centers for Disease Control and Prevention (CDC) has suggested that infected individuals maintain and six-foot distance between themselves and other household members to reduce transmission through the air by droplets and aerosols , however for persons living in overcrowded housing, complying with this recommendation may be difficult or impossible. Developing recommendations that aim to specifically address the unique needs of persons living in overcrowded housing may improve the health outcomes for this group. In addition, public health entities and healthcare providers should assess the prevalence of household overcrowding in the populations that they serve to inform interventions and more effectively allocate resources for COVID-19 prevention and control. More broadly, this study underlines how this pandemic has exacerbated the detrimental effects of the housing crisis in the US on the health of the population, and the urgent need to increase access to affordable housing to reduce morbidity and mortality from COVID-19.
Household overcrowding may increase the risk of COVID-19 mortality. Public health agencies should recognize the importance of effectively allocating resources to areas with overcrowded housing during the COVID-19 pandemic and future disease outbreaks. Our findings emphasize an imperative for further studies exploring the association between overcrowded housing and COVID-19 mortality, as well as mortality attributed to other communicable pathogens.
Limitations of our work include that our ecological analysis can only provide partial insights regarding the additional barriers experienced by populations in overcrowded housing, such as discrimination or social exclusion. Furthermore, we were unable to account for undocumented or homeless individuals, which are equally important populations to consider when addressing infection and mortality rates. Finally, while the cities in LA County encompass a large portion of the County’s population, they do not account for unincorporated areas (regions not governed by municipal corporations), which comprise a sizeable proportion of the County. Regardless of these limitations, our study emphasizes the imperative for further research and data acquisition on the association between household overcrowding and mortality due to COVID-19 infection.