This descriptive study examined the social ecology of COVID-19 risk exposure across Montreal (Quebec, Canada) by comparing fifteen neighborhoods with contrasting COVID-19 prevalence. Census 2016 data were combined with an online survey (n = 502) of residents living in the targeted neighborhoods. Chi-square and t-test were used to analyze the differences in sample proportions and means.

As of October 1, 2020, compared to the least affected Montreal neighborhoods, the most Impacted neighborhoods had a 2.6 times higher COVID-19 prevalence (2370.9 active cases per 100,000 residents) and a 2.5 times higher death rate (260.6 deaths per 100,000 people). High prevalence neighborhoods were lower income, more highly racialized, denser, and had a larger share of public transit users than least affected neighborhoods.

Compared with respondents from the least affected neighborhoods, survey respondents in high prevalence neighborhoods were more likely to report a lower income, hold at-risk occupations, live in apartment buildings, use public transit, and perceive themselves at risk of becoming infected with COVID-19 and less capable of avoiding COVID-19 transmission, but less likely to comply with stay-at-home recommendations. No significant differences between neighborhoods were found in terms of compliance with recommended COVID-19 hygiene preventive measures (mask wearing and hand washing).

suggest that at-risk occupations and a lower capacity to avoid COVID-19 exposure, but not differences in compliance with public sanitary directives, were key factors associated with higher neighborhood prevalence of COVID-19.