[Skip to Content]
[Skip to Content Landing]
Figure.  Rates of Coronavirus Disease 2019 (COVID-19) Hospitalizations and Deaths by New York City Borough
Rates of Coronavirus Disease 2019 (COVID-19) Hospitalizations and Deaths by New York City Borough

The New York City Department of Health and Mental Hygiene (DOHMH) estimates the number of patients with COVID-19 who have ever been hospitalized through data linkages with the New York City DOHMH syndromic surveillance database and the New York State Department of Health Hospital Emergence Response Data System based on key fields from known cases that are reported by laboratories to New York City DOHMH.2 Probable COVID-19 deaths are defined by the New York City DOHMH as patients who have no known positive laboratory test for severe acute respiratory syndrome coronavirus 2, but for whom the death certificate lists COVID-19 (or an equivalent) as a cause of death. Fifteen deaths were excluded because the borough of residence was unknown. The number of patients with COVID-19 who were hospitalized per 100 000 population was 634 in the Bronx; 404 in Brooklyn; 331 in Manhattan; 568 in Queens; and 373 in Staten Island. The total number of deaths per 100 000 population was 224 in the Bronx; 181 in Brooklyn; 122 in Manhattan; 200 in Queens; and 143 in Staten Island. The number of laboratory-confirmed COVID-19 deaths per 100 000 population was 173 in the Bronx; 132 in Brooklyn; 91 in Manhattan; 154 in Queens; and 117 in Staten Island. The number of probable COVID-19 deaths per 100 000 population was 51 in the Bronx; 49 in Brooklyn; 31 in Manhattan; 46 in Queens; and 27 in Staten Island.

Table.  Population and Hospital Characteristics Among New York City Boroughsa
Population and Hospital Characteristics Among New York City Boroughsa
1.
Paules  CI, Marston  HD, Fauci  AS.  Coronavirus infections—more than just the common cold.   JAMA. 2020;323(8):707-708. doi:10.1001/jama.2020.0757PubMedGoogle ScholarCrossref
2.
New York City Department of Health and Mental Hygiene. COVID-19 data. Accessed April 2, 2020. https://www1.nyc.gov/site/doh/covid/covid-19-data.page
3.
John Hopkins University Coronavirus Resource Center. Coronavirus COVID-19 global cases. Accessed April 1, 2020. https://coronavirus.jhu.edu/map.html
4.
New York City Health Department of Health and Mental Hygiene. Summary of vital statistics 2017: the city of New York. Accessed May 29, 2020. https://www1.nyc.gov/assets/doh/downloads/pdf/vs/2017sum.pdf
5.
Wadhera  RK, Wang  Y, Figueroa  JF, Dominici  F, Yeh  RW, Joynt Maddox  KE.  Mortality and hospitalizations for dually enrolled and nondually enrolled Medicare beneficiaries aged 65 years or older, 2004 to 2017.   JAMA. 2020;323(10):961-969. doi:10.1001/jama.2020.1021PubMedGoogle ScholarCrossref
6.
Yancy  CW.  COVID-19 and African Americans.  Published online April 15, 2020.  JAMA. doi:10.1001/jama.2020.6548 PubMedGoogle Scholar
Limit 200 characters
Limit 25 characters
Conflicts of Interest Disclosure

Identify all potential conflicts of interest that might be relevant to your comment.

Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.

Err on the side of full disclosure.

If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response.

Not all submitted comments are published. Please see our commenting policy for details.

Limit 140 characters
Limit 3600 characters or approximately 600 words
    1 Comment for this article
    Nursing Homes
    Charles Donahue, Mech Eng | SII
    I find it odd since ~half of the deaths came from nursing homes. There was no discussion regarding this. This study seems to start with an agenda and try and shed light on the disparity between wealth and outcome. It did very little to help shine light on the potential reasons behind this data.
    CONFLICT OF INTEREST: None Reported
    Views 67,346
    Citations 0
    Research Letter
    April 29, 2020

    Variation in COVID-19 Hospitalizations and Deaths Across New York City Boroughs

    Author Affiliations
    • 1Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
    • 2Department of Medicine, NYU Langone Medical Center, New York, New York
    • 3Department of Medicine, New York Presbyterian/Columbia University Medical Center, New York, New York
    • 4Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
    • 5Cardiovascular Division, Washington University School of Medicine in St Louis, St Louis, Missouri
    • 6Associate Editor, JAMA
    JAMA. Published online April 29, 2020. doi:10.1001/jama.2020.7197

    In the US, New York City has emerged as the epicenter of the coronavirus disease 2019 (COVID-19) outbreak.1 As of April 25, 2020, more than 150 000 cases had been reported, which is approximately 17% of total cases in the US.2,3 New York City is composed of 5 boroughs (the Bronx, Brooklyn, Manhattan, Queens, and Staten Island), each with unique demographic, socioeconomic, and community characteristics.

    Prior analyses have shown health inequities across these boroughs, but whether similar patterns have also emerged amid the COVID-19 pandemic is unknown.4 Understanding the patterns could inform public health and policy strategies to mitigate the ongoing spread of COVID-19, and future approaches to address a possible resurgence of the disease. Therefore, in this study, we aimed to examine population characteristics and hospital bed capacities across the 5 boroughs and evaluate whether differences in the rates of COVID-19 testing, hospitalizations, and deaths have emerged in these communities.

    Methods

    The 2018 American Community Survey, an annual nationwide audit conducted by the US Census Bureau, was used to describe the population characteristics of the 5 New York City boroughs. Hospitals and their bed capacities were identified using the American Hospital Association 2016 file and a manual search of hospital websites.

    The cumulative number of COVID-19 tests performed, the number of patients with COVID-19 who were hospitalized, and the number of deaths related to COVID-19 according to borough of residence for each patient were obtained using data from the New York City Department of Health and Mental Hygiene and last updated on April 25, 2020.2 Both laboratory-confirmed and probable COVID-19 deaths were examined.

    Descriptive statistical analyses were performed to calculate the total number of COVID-19 tests, hospitalizations, and deaths per 100 000 persons using the population of each borough as a denominator. Institutional review board approval was not sought due to the use of publicly available, deidentified data, per usual institutional policy.

    Results

    The total population of New York City was 8 398 748. Across the 5 boroughs, the population density ranged from 8112 per square mile in Staten Island to 71 434 per square mile in Manhattan (Table). The proportion of older adults (aged ≥65 years) was lowest in the Bronx (12.8%) and highest in Manhattan (16.5%), whereas the proportion of black or African American persons was highest in the Bronx (38.3%) and lowest in Staten Island (11.5%).

    Household median income was lowest in the Bronx ($38 467) as was the proportion of persons with a bachelor’s degree or higher (20.7%). There were 48 short-term acute care hospitals. The number of hospitals per borough ranged from 2 in Staten Island to 16 in Manhattan. The number of hospital beds per 100 000 population was lowest in Queens (144 beds) and highest in the Bronx (336 beds) and in Manhattan (534 beds).

    Among New York City boroughs, there was variation in the number of COVID-19 tests performed per 100 000 population (4599 in the Bronx; 2970 in Brooklyn; 2844 in Manhattan; 3800 in Queens; and 5603 in Staten Island). The number of patients with COVID-19 who were hospitalized per 100 000 population was highest in the Bronx (634) and lowest in Manhattan (331). The number of deaths related to COVID-19 per 100 000 population was also highest in the Bronx (224) and lowest in Manhattan (122) (Figure).

    Discussion

    The substantial variation in the rates for COVID-19 hospitalizations and deaths across the New York City boroughs is concerning. The Bronx, which has the highest proportion of racial/ethnic minorities, the most persons living in poverty, and the lowest levels of educational attainment had higher rates of hospitalization and death related to COVID-19 than the other 4 boroughs.

    In contrast, the rates for hospitalizations and deaths were lowest among residents of the most affluent borough, Manhattan, which is composed of a predominately white population. Manhattan and the Bronx have the highest number of per capita hospital beds, and Manhattan has the highest population density, indicating that other factors, such as underlying comorbid illnesses, occupational exposures, socioeconomic determinants, and race-based structural inequities may explain the disparate outcomes among the boroughs.5,6

    This study has limitations, including an ecological design and limited follow-up through April 25, 2020. Demographic characteristics for patients who died were not available by borough of residence. The rate of COVID-19 cases was not evaluated given significant variability in testing.

    Further studies are needed to examine whether the disproportionate burden of COVID-19 is being borne by lower income and minority communities in other regions of the US.

    Section Editor: Jody W. Zylke, MD, Deputy Editor.
    Back to top
    Article Information

    Accepted for Publication: April 20, 2020.

    Corresponding Author: Rishi K. Wadhera, MD, MPP, MPhil, Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 375 Longwood Ave, Boston, MA 02215 (rwadhera@bidmc.harvard.edu).

    Published Online: April 29, 2020. doi:10.1001/jama.2020.7197

    Author Contributions: Drs R. Wadhera and Shen had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Drs Yeh and Shen contributed equally.

    Concept and design: R. Wadhera, P. Wadhera, Gaba, Figueroa, Yeh, Shen.

    Acquisition, analysis, or interpretation of data: R. Wadhera, Figueroa, Joynt Maddox, Shen.

    Drafting of the manuscript: R. Wadhera, Figueroa.

    Critical revision of the manuscript for important intellectual content: All authors.

    Statistical analysis: R. Wadhera, Gaba, Shen.

    Administrative, technical, or material support: R. Wadhera.

    Supervision: P. Wadhera, Yeh.

    Conflict of Interest Disclosures: Dr R. Wadhera reported receiving research support from the National Heart, Lung, and Blood Institute (grant K23HL148525-1) and previously serving as a consultant for Regeneron. Dr Figueroa reported receiving research support from the National Center for Advancing Translational Sciences (grant KL2 TR002542) and the Commonwealth Fund. Dr Joynt Maddox reported receiving research support from the National Heart, Lung, and Blood Institute (grant R01HL143421) and the National Institute on Aging (grant R01AG060935); receiving grant support from the Commonwealth Fund; and having prior contract work with the Office of the Assistant Secretary for Planning and Evaluation. Dr Yeh reported receiving research support from the National Heart, Lung, and Blood Institute (grant R01HL136708); serving as a consultant to Biosense Webster; and serving as a consultant to and receiving grants from Abbott Vascular, AstraZeneca, Boston Scientific, and Medtronic. No other disclosures were reported.

    Funding/Support: This work was supported by the Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology.

    Role of the Funder/Sponsor: The funder/sponsor had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

    Disclaimer: Dr Joynt Maddox is Associate Editor of JAMA, but she was not involved in any of the decisions regarding review of the manuscript or its acceptance.

    References
    1.
    Paules  CI, Marston  HD, Fauci  AS.  Coronavirus infections—more than just the common cold.   JAMA. 2020;323(8):707-708. doi:10.1001/jama.2020.0757PubMedGoogle ScholarCrossref
    2.
    New York City Department of Health and Mental Hygiene. COVID-19 data. Accessed April 2, 2020. https://www1.nyc.gov/site/doh/covid/covid-19-data.page
    3.
    John Hopkins University Coronavirus Resource Center. Coronavirus COVID-19 global cases. Accessed April 1, 2020. https://coronavirus.jhu.edu/map.html
    4.
    New York City Health Department of Health and Mental Hygiene. Summary of vital statistics 2017: the city of New York. Accessed May 29, 2020. https://www1.nyc.gov/assets/doh/downloads/pdf/vs/2017sum.pdf
    5.
    Wadhera  RK, Wang  Y, Figueroa  JF, Dominici  F, Yeh  RW, Joynt Maddox  KE.  Mortality and hospitalizations for dually enrolled and nondually enrolled Medicare beneficiaries aged 65 years or older, 2004 to 2017.   JAMA. 2020;323(10):961-969. doi:10.1001/jama.2020.1021PubMedGoogle ScholarCrossref
    6.
    Yancy  CW.  COVID-19 and African Americans.  Published online April 15, 2020.  JAMA. doi:10.1001/jama.2020.6548 PubMedGoogle Scholar
    ×