Display options
Cite
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):e048086doi: 10.1136/bmjopen-2020-048086.
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, 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. 11,7 (2021): e048086. doi: https://doi.org/10.1136/bmjopen-2020-048086
Islam SJ, Nayak A, Hu Y, Mehta A, Dieppa K, Almuwaqqat Z, Ko YA, Patel SA, Goyal A, Sullivan S, Lewis TT, Vaccarino V, Morris AA, Quyyumi AA. 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 Jul 22;11(7):e048086. doi: 10.1136/bmjopen-2020-048086. PMID: 34301657; PMCID: PMC8300549.
Copy Download .nbib Format: NLM
Share it on

BMJ Open. 2021 Jul 22;11(7):e048086. doi: 10.1136/bmjopen-2020-048086.

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

Shabatun J Islam, Aditi Nayak, Yingtian Hu, Anurag Mehta, Katherine Dieppa, Zakaria Almuwaqqat, Yi-An Ko, Shivani A Patel, Abhinav Goyal, Samaah Sullivan, Tené T Lewis, Viola Vaccarino, Alanna A Morris, Arshed A Quyyumi

Affiliations

  1. Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA.
  2. Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.
  3. City Operations, Getaround Incorporated, San Francisco, California, USA.
  4. Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.
  5. Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA [email protected].

PMID: 34301657 PMCID: PMC8300549 DOI: 10.1136/bmjopen-2020-048086

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.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Keywords: COVID-19; epidemiology; public health; social medicine

Conflict of interest statement

Competing interests: None declared.

References

  1. Health Educ Behav. 2020 Aug;47(4):509-513 - PubMed
  2. J Epidemiol Community Health. 2004 Jun;58(6):476-80 - PubMed
  3. PLoS One. 2014 Apr 28;9(4):e84380 - PubMed
  4. BMC Health Serv Res. 2010 Aug 20;10:245 - PubMed
  5. J Environ Health. 2018 Jun;80(10):34-36 - PubMed
  6. Health Serv Res. 2007 Feb;42(1 Pt 1):286-310 - PubMed
  7. Public Adm Rev. 2020 Jun 22;: - PubMed
  8. Am J Public Health. 2011 Feb;101(2):285-93 - PubMed
  9. PLoS One. 2021 Mar 24;16(3):e0248702 - PubMed
  10. J Gen Intern Med. 2020 Sep;35(9):2784-2787 - PubMed
  11. J Health Soc Behav. 1994 Dec;35(4):370-84 - PubMed
  12. Am J Public Health. 2009 Oct;99 Suppl 2:S261-70 - PubMed
  13. Am J Prev Med. 2020 Sep;59(3):317-325 - PubMed
  14. MMWR Morb Mortal Wkly Rep. 2020 Dec 04;69(48):1812-1816 - PubMed
  15. Proc Natl Acad Sci U S A. 2020 Aug 18;117(33):19658-19660 - PubMed
  16. Lancet. 2017 Apr 8;389(10077):1453-1463 - PubMed
  17. JAMA. 2020 Jul 28;324(4):390-392 - PubMed
  18. JAMA. 2020 May 19;323(19):1891-1892 - PubMed
  19. J Health Soc Behav. 2008 Dec;49(4):367-84 - PubMed
  20. JAMA Netw Open. 2020 Sep 1;3(9):e2021892 - PubMed

MeSH terms

Publication Types

Grant support