COVID-19 Deaths and Minority Health Social Vulnerability, in the U.S., January 1, 2020 through June 24, 2023

Hope King; Makhabele Nolana Woolfork; Andrea Yunyou; Yuwa Edomwande; Erik Euler; Olivia Almendares; Suresh Nath Neupane; Melissa Briggs Hagen

doi:10.1007/s40615-024-02192-w

COVID-19 Deaths and Minority Health Social Vulnerability, in the U.S., January 1, 2020 through June 24, 2023

J Racial Ethn Health Disparities. 2024 Oct 11. doi: 10.1007/s40615-024-02192-w. Online ahead of print.

Authors

Hope King^{1

2}, Makhabele Nolana Woolfork³, Andrea Yunyou⁴, Yuwa Edomwande⁴, Erik Euler⁴, Olivia Almendares⁵, Suresh Nath Neupane⁶, Melissa Briggs Hagen⁵

Affiliations

¹ Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases (NCIRD), Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA. hking@cdc.gov.
² Centers for Disease Control and Prevention, 1600 Clifton Road NE, Bldg 24, Mailstop H24-9, Atlanta, GA, 30333, USA. hking@cdc.gov.
³ Office of the Director, National Center for Immunization and Respiratory Diseases (NCIRD), Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA.
⁴ Booz Allen Hamilton, McLean, VA, USA.
⁵ Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases (NCIRD), Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA.
⁶ Andrew Young School of Policy Studies, Georgia State University, Atlanta, GA, USA.

PMID: 39392568
DOI: 10.1007/s40615-024-02192-w

Abstract

Background: Health disparities, leading to worse health outcomes such as elevated COVID-19 mortality rates, are rooted in social and structural factors. These disparities notably impact individuals from lower socioeconomic backgrounds and more socially vulnerable areas. We analyzed the relationship between COVID-19 deaths and social vulnerability using the Minority Health Social Vulnerability Index (MHSVI).

Methods: COVID-19 death data in the U.S. was obtained from the Centers for Disease Control and Prevention (CDC) National Center for Health Statistics, where COVID-19 deaths were defined using the ICD-10 code U07.1. MHSVI composite scores were calculated for 3089 U.S. counties and categorized into social vulnerability quartiles, where values ranged from 0 (lowest vulnerability) to 1 (highest vulnerability). Negative binomial regression was employed to determine death rate ratios for each quartile within each theme. Finally, a multivariate negative binomial regression including all MHSVI sub-themes, excluding the overall index ranking, was used to assess the association between each theme and COVID-19 death rates independently.

Results: There were 1,134,272 COVID-19 deaths from January 1, 2020 through June 24, 2023. Adjusted rate ratios for COVID-19 deaths in the overall index ranking were 1.06 (95% CI 0.99-1.13), 1.14 (95% CI 1.06-1.22), and 1.41 (95% CI 1.31-1.52) for the second, third and fourth quartiles, respectively. Sub-themes of socioeconomic status (SES), household characteristics (HC), racial and ethnic minority status (REMS), housing type and transportation (HTT), and medical vulnerability (MV) revealed increasing death rates in higher vulnerability quartiles. The healthcare infrastructure and access (HIA) theme had decreasing death rate ratios of 0.74 (95% CI 0.71-0.78), 0.59 (95% CI 0.56-0.62), and 0.42 (95% CI 0.39-0.44) for the second, third, and fourth quartiles, respectively. Finally, the multivariate analysis showed that the HC, HTT, HIA, and MV themes were associated with COVID-19 deaths (P < 0.05).

Conclusion: Counties that were identified as more socially vulnerable experienced higher death rates from COVID-19. These areas may need additional public health and social support during future pandemics.

Keywords: COVID-19; Health disparities; Social determinants of health; Social vulnerability.