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Impact of Social Vulnerability on COVID-19 Incidence and Outcomes in the United States.
medRxiv. 2020 Apr 17M

Abstract

Importance Prior pandemics have disparately affected socially vulnerable communities. Whether regional variations in social vulnerability to disasters influence COVID-19 outcomes and incidence in the U.S. is unknown. Objective To examine the association of Social Vulnerability Index (SVI), a percentile-based measure of county-level social vulnerability to disasters, and its sub-components (socioeconomic status, household composition, minority status, and housing type/transportation accessibility) with the case fatality rate (CFR) and incidence of COVID-19. Design Ecological study of counties with at least 50 confirmed COVID-19 cases as of April 4th, 2020. Generalized linear mixed-effects models with state-level clustering were applied to estimate county-level associations of overall SVI and its sub-component scores with COVID-19 CFR (deaths/100 cases) and incidence (cases/1000 population), adjusting for population percentage aged >65 years, and for comorbidities using the average Hierarchical Condition Category (HCC) score. Counties with high SVI (≥median) and high CFR (≥median) were identified. Setting Population-based study of U.S. county-level data. Participants U.S. counties with at least 50 confirmed COVID-19 cases. Main outcomes and measures COVID-19 CFR and incidence. Results Data from 433 counties including 283,256 cases and 6,644 deaths were analyzed. Median SVI was 0.46 [Range: 0.01-1.00], and median CFR and incidence were 1.9% [Range: 0-13.3] and 1.2 per 1000 people [Range: 0.6-38.8], respectively. Higher SVI, indicative of greater social vulnerability, was associated with higher CFR (RR: 1.19 [1.05, 1.34], p=0.005, per-1 unit increase), an association that strengthened after adjustment for age>65 years and comorbidities (RR: 1.63 [1.38, 1.91], p<0.001), and was further confirmed in a sensitivity analysis limited to six states with the highest testing levels. Although the association between overall SVI and COVID-19 incidence was not significant, the SVI sub-components of socioeconomic status and minority status were both predictors of higher incidence and CFR. A combination of high SVI (≥0.46) and high adjusted CFR (≥2.3%) was observed in 28.9% of counties. Conclusions and Relevance Social vulnerability is associated with higher COVID-19 case fatality. High social vulnerability and CFR coexist in more than 1 in 4 U.S. counties. These counties should be targeted by public policy interventions to help alleviate the pandemic burden on the most vulnerable population.

Authors

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Pub Type(s)

Preprint

Language

eng

PubMed ID

32511437

Citation

Nayak, Aditi, et al. "Impact of Social Vulnerability On COVID-19 Incidence and Outcomes in the United States." MedRxiv : the Preprint Server for Health Sciences, 2020.
Nayak A, Islam SJ, Mehta A, et al. Impact of Social Vulnerability on COVID-19 Incidence and Outcomes in the United States. medRxiv. 2020.
Nayak, A., Islam, S. J., Mehta, A., Ko, Y. A., Patel, S. A., Goyal, A., Sullivan, S., Lewis, T. T., Vaccarino, V., Morris, A. A., & Quyyumi, A. A. (2020). Impact of Social Vulnerability on COVID-19 Incidence and Outcomes in the United States. MedRxiv : the Preprint Server for Health Sciences. https://doi.org/10.1101/2020.04.10.20060962
Nayak A, et al. Impact of Social Vulnerability On COVID-19 Incidence and Outcomes in the United States. medRxiv. 2020 Apr 17; PubMed PMID: 32511437.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Impact of Social Vulnerability on COVID-19 Incidence and Outcomes in the United States. AU - Nayak,Aditi, AU - Islam,Shabatun J, AU - Mehta,Anurag, AU - Ko,Yi-An, AU - Patel,Shivani A, AU - Goyal,Abhinav, AU - Sullivan,Samaah, AU - Lewis,Tene T, AU - Vaccarino,Viola, AU - Morris,Alanna A, AU - Quyyumi,Arshed A, Y1 - 2020/04/17/ PY - 2020/6/9/pubmed PY - 2020/6/9/medline PY - 2020/6/9/entrez JF - medRxiv : the preprint server for health sciences JO - medRxiv N2 - Importance Prior pandemics have disparately affected socially vulnerable communities. Whether regional variations in social vulnerability to disasters influence COVID-19 outcomes and incidence in the U.S. is unknown. Objective To examine the association of Social Vulnerability Index (SVI), a percentile-based measure of county-level social vulnerability to disasters, and its sub-components (socioeconomic status, household composition, minority status, and housing type/transportation accessibility) with the case fatality rate (CFR) and incidence of COVID-19. Design Ecological study of counties with at least 50 confirmed COVID-19 cases as of April 4th, 2020. Generalized linear mixed-effects models with state-level clustering were applied to estimate county-level associations of overall SVI and its sub-component scores with COVID-19 CFR (deaths/100 cases) and incidence (cases/1000 population), adjusting for population percentage aged >65 years, and for comorbidities using the average Hierarchical Condition Category (HCC) score. Counties with high SVI (≥median) and high CFR (≥median) were identified. Setting Population-based study of U.S. county-level data. Participants U.S. counties with at least 50 confirmed COVID-19 cases. Main outcomes and measures COVID-19 CFR and incidence. Results Data from 433 counties including 283,256 cases and 6,644 deaths were analyzed. Median SVI was 0.46 [Range: 0.01-1.00], and median CFR and incidence were 1.9% [Range: 0-13.3] and 1.2 per 1000 people [Range: 0.6-38.8], respectively. Higher SVI, indicative of greater social vulnerability, was associated with higher CFR (RR: 1.19 [1.05, 1.34], p=0.005, per-1 unit increase), an association that strengthened after adjustment for age>65 years and comorbidities (RR: 1.63 [1.38, 1.91], p<0.001), and was further confirmed in a sensitivity analysis limited to six states with the highest testing levels. Although the association between overall SVI and COVID-19 incidence was not significant, the SVI sub-components of socioeconomic status and minority status were both predictors of higher incidence and CFR. A combination of high SVI (≥0.46) and high adjusted CFR (≥2.3%) was observed in 28.9% of counties. Conclusions and Relevance Social vulnerability is associated with higher COVID-19 case fatality. High social vulnerability and CFR coexist in more than 1 in 4 U.S. counties. These counties should be targeted by public policy interventions to help alleviate the pandemic burden on the most vulnerable population. UR - https://www.unboundmedicine.com/medline/citation/32511437/Impact_of_Social_Vulnerability_on_COVID_19_Incidence_and_Outcomes_in_the_United_States_ L2 - https://doi.org/10.1101/2020.04.10.20060962 DB - PRIME DP - Unbound Medicine ER -
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