Background: The COVID-19 pandemic highlighted significant health disparities across the United States, with Texas ranking among the lowest in healthcare quality. This study explores the relationship between county-level factors and COVID-19 cases in Texas daycare centers. Unlike broader studies on COVID-19 disparities, this research uniquely examines the daycare population, a critical yet understudied environment, through county-level social determinants of health. Methods: Using 2020-2022 Covid data from the Texas Health & Human Services Commission and the 2020 County Health Rankings, we analyzed COVID-19 case counts among children and staff in licensed daycare facilities across 225 Texas counties. We classified counties into 4 patterns: high child-high staff, high child-low staff, low child-high staff, and low child-low staff. We also examined the association between county-level determinants and pandemic patterns. Results: Counties with higher COVID-19 cases in daycare centers have higher proportions of racial/ethnic minorities, but with better access to primary care physicians, better socioeconomic conditions (eg, % of children in poverty and median household income) and greater urbanization ( P < .05). Spatial analysis of child and staff cases show the clustered transmission areas, in which southeastern counties with more Native Indians (1.48%) have a higher number of staff affected by COVID-19 than counties with fewer Native Indians (1.21%-1.26%). Conclusion: These findings underscore the influence of better access to screening on the COVID-19 counts, highlighting the importance of epidemiological surveillance. Improving healthcare access, addressing economic inequalities, and tailoring mitigation strategies are key to closing the gaps in different transmission rates among daycare centers.
Potturu et al. (Thu,) studied this question.