This cross-sectional study investigates associations of residential building characteristics and markers of neighborhood socioeconomic status (SES) with screen-detected SARS-CoV-2 prevalence among pregnant women delivering in 2 New York City hospitals.

The authors examined 434 New York City residents who delivered at NewYork-Presbyterian/Columbia University Irving Medical Center or Allen Hospital after implementation of universal SARS-CoV-2 nasopharyngeal quantitative reverse transcriptase–polymerase chain reaction testing at the time of admission to the labor and delivery unit from March 22 through April 21, 2020. They linked electronic health record data to demographic, socioeconomic, and housing data derived from the US Census.

Of the 434 New York City residents who were tested for SARS-CoV-2 during the study period, 396 patients (91%) were included in this study; of those patients, 71 (17.9%) were infected with SARS-CoV-2. The likelihood of SARS-CoV-2 varied substantially across measures of built environment and neighborhood socioeconomic status, with the lowest probability of infection estimated for women living in buildings with very high assessed values (8.2% [95% CI, 1.2%-15.2%]) and the highest  for those residing in neighborhoods with high household membership (23.9% [95% CI, 18.4%-29.4%]).

Odds of infection were lower among women living in buildings with more residential units (interdecile OR, 0.34 [95% CI, 0.16-0.72]) and higher assessed values (interdecile OR, 0.29 [95% CI, 0.10-0.89]) and in neighborhoods with higher median incomes (interdecile OR, 0.32 [95% CI, 0.12-0.83]).

Odds of infection were higher among women residing in neighborhoods with high unemployment rates (interdecile OR, 2.13 [95 CI, 1.18-3.83]), large household membership (interdecile OR, 3.16 [95% CI, 1.58-6.37]), and greater household crowding (interdecile OR, 2.27 [95% CI, 1.12-4.61]). There was no statistically significant association between SARS-CoV-2 infection and population density (interdecile OR, 0.70 [95% CI, 0.32-1.51]) or poverty rate (interdecile OR, 2.03 [95% CI, 0.97-4.25]). Neighborhood-level variables were moderately to highly correlated (|r|, 0.66-0.83).

In summary, SARS-CoV-2 transmission among pregnant women in New York City was associated with neighborhood- and building-level markers of large household membership, household crowding, and low socioeconomic status.