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Temporal trends in the association of social vulnerability and race/ethnicity with county-level COVID-19 incidence and outcomes in the USA: an ecological analysis.
BMJ Open. 2021 07 22; 11(7):e048086.BO

Abstract

BACKGROUND

The COVID-19 pandemic adversely affected the socially vulnerable and minority communities in the USA initially, but the temporal trends during the year-long pandemic remain unknown.

OBJECTIVE

We examined the temporal association of county-level Social Vulnerability Index (SVI), a percentile-based measure of social vulnerability to disasters, its subcomponents and race/ethnic composition with COVID-19 incidence and mortality in the USA in the year starting in March 2020.

METHODS

Counties (n=3091) with ≥50 COVID-19 cases by 6 March 2021 were included in the study. Associations between SVI (and its subcomponents) and county-level racial composition with incidence and death per capita were assessed by fitting a negative-binomial mixed-effects model. This model was also used to examine potential time-varying associations between weekly number of cases/deaths and SVI or racial composition. Data were adjusted for percentage of population aged ≥65 years, state-level testing rate, comorbidities using the average Hierarchical Condition Category score, and environmental factors including average fine particulate matter of diameter ≥2.5 μm, temperature and precipitation.

RESULTS

Higher SVI, indicative of greater social vulnerability, was independently associated with higher COVID-19 incidence (adjusted incidence rate ratio per 10 percentile increase: 1.02, 95% CI 1.02 to 1.03, p<0.001) and death per capita (1.04, 95% CI 1.04 to 1.05, p<0.001). SVI became an independent predictor of incidence starting from March 2020, but this association became weak or insignificant by the winter, a period that coincided with a sharp increase in infection rates and mortality, and when counties with higher proportion of white residents were disproportionately represented ('third wave'). By spring of 2021, SVI was again a predictor of COVID-19 outcomes. Counties with greater proportion of black residents also observed similar temporal trends in COVID-19-related adverse outcomes. Counties with greater proportion of Hispanic residents had worse outcomes throughout the duration of the analysis.

CONCLUSION

Except for the winter 'third wave', when majority of the white communities had the highest incidence of cases, counties with greater social vulnerability and proportionately higher minority populations experienced worse COVID-19 outcomes.

Authors+Show Affiliations

Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA.Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA.Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA.City Operations, Getaround Incorporated, San Francisco, California, USA.Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA.Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA.Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA.Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA aquyyum@emory.edu.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

34301657

Citation

Islam, Shabatun J., et al. "Temporal Trends in the Association of Social Vulnerability and Race/ethnicity With County-level COVID-19 Incidence and Outcomes in the USA: an Ecological Analysis." BMJ Open, vol. 11, no. 7, 2021, pp. e048086.
Islam SJ, Nayak A, Hu Y, et al. Temporal trends in the association of social vulnerability and race/ethnicity with county-level COVID-19 incidence and outcomes in the USA: an ecological analysis. BMJ Open. 2021;11(7):e048086.
Islam, S. J., Nayak, A., Hu, Y., Mehta, A., Dieppa, K., Almuwaqqat, Z., Ko, Y. A., Patel, S. A., Goyal, A., Sullivan, S., Lewis, T. T., Vaccarino, V., Morris, A. A., & Quyyumi, A. A. (2021). Temporal trends in the association of social vulnerability and race/ethnicity with county-level COVID-19 incidence and outcomes in the USA: an ecological analysis. BMJ Open, 11(7), e048086. https://doi.org/10.1136/bmjopen-2020-048086
Islam SJ, et al. Temporal Trends in the Association of Social Vulnerability and Race/ethnicity With County-level COVID-19 Incidence and Outcomes in the USA: an Ecological Analysis. BMJ Open. 2021 07 22;11(7):e048086. PubMed PMID: 34301657.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Temporal trends in the association of social vulnerability and race/ethnicity with county-level COVID-19 incidence and outcomes in the USA: an ecological analysis. AU - Islam,Shabatun J, AU - Nayak,Aditi, AU - Hu,Yingtian, AU - Mehta,Anurag, AU - Dieppa,Katherine, AU - Almuwaqqat,Zakaria, AU - Ko,Yi-An, AU - Patel,Shivani A, AU - Goyal,Abhinav, AU - Sullivan,Samaah, AU - Lewis,Tené T, AU - Vaccarino,Viola, AU - Morris,Alanna A, AU - Quyyumi,Arshed A, Y1 - 2021/07/22/ PY - 2021/7/24/entrez PY - 2021/7/25/pubmed PY - 2021/7/30/medline KW - COVID-19 KW - epidemiology KW - public health KW - social medicine SP - e048086 EP - e048086 JF - BMJ open JO - BMJ Open VL - 11 IS - 7 N2 - BACKGROUND: The COVID-19 pandemic adversely affected the socially vulnerable and minority communities in the USA initially, but the temporal trends during the year-long pandemic remain unknown. OBJECTIVE: We examined the temporal association of county-level Social Vulnerability Index (SVI), a percentile-based measure of social vulnerability to disasters, its subcomponents and race/ethnic composition with COVID-19 incidence and mortality in the USA in the year starting in March 2020. METHODS: Counties (n=3091) with ≥50 COVID-19 cases by 6 March 2021 were included in the study. Associations between SVI (and its subcomponents) and county-level racial composition with incidence and death per capita were assessed by fitting a negative-binomial mixed-effects model. This model was also used to examine potential time-varying associations between weekly number of cases/deaths and SVI or racial composition. Data were adjusted for percentage of population aged ≥65 years, state-level testing rate, comorbidities using the average Hierarchical Condition Category score, and environmental factors including average fine particulate matter of diameter ≥2.5 μm, temperature and precipitation. RESULTS: Higher SVI, indicative of greater social vulnerability, was independently associated with higher COVID-19 incidence (adjusted incidence rate ratio per 10 percentile increase: 1.02, 95% CI 1.02 to 1.03, p<0.001) and death per capita (1.04, 95% CI 1.04 to 1.05, p<0.001). SVI became an independent predictor of incidence starting from March 2020, but this association became weak or insignificant by the winter, a period that coincided with a sharp increase in infection rates and mortality, and when counties with higher proportion of white residents were disproportionately represented ('third wave'). By spring of 2021, SVI was again a predictor of COVID-19 outcomes. Counties with greater proportion of black residents also observed similar temporal trends in COVID-19-related adverse outcomes. Counties with greater proportion of Hispanic residents had worse outcomes throughout the duration of the analysis. CONCLUSION: Except for the winter 'third wave', when majority of the white communities had the highest incidence of cases, counties with greater social vulnerability and proportionately higher minority populations experienced worse COVID-19 outcomes. SN - 2044-6055 UR - https://www.unboundmedicine.com/medline/citation/34301657/Temporal_trends_in_the_association_of_social_vulnerability_and_race/ethnicity_with_county_level_COVID_19_incidence_and_outcomes_in_the_USA:_an_ecological_analysis_ L2 - https://bmjopen.bmj.com/lookup/pmidlookup?view=long&amp;pmid=34301657 DB - PRIME DP - Unbound Medicine ER -