Social Disadvantages Associated with Higher Rates of COVID-19 Cases, Death


US counties that scored higher on the Social Vulnerability Index, which includes such factors as poverty, unemployment and education, saw higher incidence rates of COVID-19 cases and deaths, a University of Michigan study found.

social inequities

Areas of the United States with greater sociodemographic disadvantages saw higher rates of coronavirus disease 2019 (COVID-19) cases and deaths, a University of Michigan study found.

The study, published in JAMA Network Open, examined county-by-county data collected from Jan. 20 to July 29, including 4,289,283 COVID-19 cases and 147,074 COVID-19 deaths.

“The biggest takeaway from this paper is that high levels of social disadvantage in communities place all at increased risk of COVID-19 infection and death,” senior author Renuka Tipirneni, MD, MSc, assistant professor, Division of General Medicine, University of Michigan, Department of Internal Medicine, told Contagion®. “This highlights that underlying inequality and social disadvantage, and its role in promoting the spread of the coronavirus, is a problem that affects all of us, no matter where we live.”

Investigators analyzed COVID-19 cases and deaths along with socioeconomic data from the US Centers for Disease Control and Prevention’s Social Vulnerability Index (SVI). The SVI includes factors such as poverty, education, unemployment, income, access to vehicles and crowded housing.

The study found that a 0.1-point increase in the overall SVI score was associated with a 14.3% increase in COVID-19 incidence rate (IRR, 1.14; 95% CI, 1.13-1.16; P < .001) and 13.7% increase in mortality rate (IRR, 1.14; 95% CI, 1.12-1.16; P < .001), amounting to 87 more cases and 3 more deaths per 100,000 population.

“It was notable to see how high levels of social disadvantage affected many diverse counties across the US,” Tipirneni said. “This evidence contradicts the perception that COVID-19 mostly affects just one set of people in one kind of area. While the first surge was mainly in urban areas with high percentages of Black and Latinx residents, as time went on some of highest rates of cases and deaths were in rural counties with predominantly white populations. But across the board, we found the areas hardest-hit by the disease were linked by higher rates of social disadvantage.”

During the study period, Trousdale County, Tennessee, which had an SVI score of 0.52, reported the highest incidence rate of COVID-19 (16,348 cases per 100,000 residents). Hancock County, Georgia, which had an SVI score of 0.8, had the highest death rate (398 deaths per 100,000 population). The states with the highest incidence rates were Arizona, Connecticut, Delaware, the District of Columbia, and Rhode Island.

“When caring for people with COVID-19, clinicians should think about what underlying social risk factors may have contributed to their infection,” Tipirneni said. “Ideally in the treatment plan would not only be the clinic or hospital treatments for COVID-19, but also dedicated measures to address people’s social needs that may continue to put them and their communities at risk.”

Each 0.1-point increase in an index of racial/ethnic minority status and limited English proficiency was associated with a 21.7% increase in incidence rate (IRR, 1.22; 95% CI, 1.20-1.23; P < .001), and 16.9% increase in mortality rate (IRR, 1.17; 95% CI, 1.14-1.19; P < .001).

“As we identified crowded housing and limited English proficiency as some of the factors most strongly associated with COVID-19 cases and deaths, public health and health care groups should work to prevent evictions and ensure housing stability during the pandemic,” Tipirneni said. “They should also communicate public health messages in languages other than English.”

The study confirms previous research that has demonstrated racial disparities of the disease in the United States. A study of adults hospitalized at Massachusetts General Hospital early in the pandemic found that chest X-rays showed that people of color were more likely to show increased disease severity and a higher risk of adverse outcomes.

Disparities in how the pandemic has affected different socioeconomic, racial and geographic areas have been seen throughout the world. A study from the United Kingdom found higher rates of critical illness among Black, Asian, and minority ethnic (BAME) peoples in Wales and the UK.

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