An ecological analysis was conducted at the modified zip code tabulation area (MODZCTA) level; there are 178 MODZCTAs in New York City. Cumulative COVID-19 death rates through December 2, 2020 were extracted by MODZCTA from the New York City (NYC) Department of Health (DOH) Coronavirus repository. Age-adjusted prevalence (%) of self-reported influenza vaccination in the previous year, diabetes, asthma, BMI ≥ 30 kg/m
2, and hypertension by United Hospital Fund (UHF) neighborhood were sourced from the 2017 Community Health Survey (CHS) via the Department of Health and Mental Hygiene’s EpiQuery tool [
9]. Inclusion of diabetes, asthma, BMI ≥ 30 kg/m
2, and hypertension was based on CDC-defined risk factors of severe COVID-19 infection [
8]. Other covariates of interest, including the percent of residents who were white, Hispanic, and ≥ 65 years old in each ZCTA, were extracted from the American Community Survey (ACS) 2018 5-year estimates [
10]. Data for CHS and ACS indicators were converted to MODZCTA using crosswalks provided by the NYC DOH [
11,
12]. This study is exempt from IRB approval as data used is de-identified and publicly available. We conducted a multivariable linear regression analysis to assess the MODZCTA level association of COVID-19 death rates with prevalence of influenza vaccination in 2017, adjusting for possible confounders. All methods were carried out in accordance with relevant guidelines and regulations' or the 'Declaration of Helsinki'.