Social inequality and the syndemic of chronic disease and COVID-19: County-level analysis in the USA
Social inequality and the syndemic of chronic disease and COVID-19: County-level analysis in the USA
Background: given the effect of chronic diseases on risk of severe COVID-19 infection, the present pandemic may have a particularly profound impact on socially disadvantaged counties.
Methods: counties in the USA were categorised into five groups by level of social vulnerability, using the Social Vulnerability Index (a widely used measure of social disadvantage) developed by the US Centers for Disease Control and Prevention. The incidence and mortality from COVID-19, and the prevalence of major chronic conditions were calculated relative to the least vulnerable quintile using Poisson regression models.
Results: among 3141 counties, there were 5 010 496 cases and 161 058 deaths from COVID-19 by 10 August 2020. Relative to the least vulnerable quintile, counties in the most vulnerable quintile had twice the rates of COVID-19 cases and deaths (rate ratios 2.11 (95% CI 1.97 to 2.26) and 2.42 (95% CI 2.22 to 2.64), respectively). Similarly, the prevalence of major chronic conditions was 24%–41% higher in the most vulnerable counties. Geographical clustering of counties with high COVID-19 mortality, high chronic disease prevalence and high social vulnerability was found, especially in southern USA.
Conclusion: some counties are experiencing a confluence of epidemics from COVID-19 and chronic diseases in the context of social disadvantage. Such counties are likely to require enhanced public health and social support.
covid-19, inequality, Vulnerabilities
496-500
Islam, Md Nazrul
e5345196-7479-438f-b4f6-c372d2135586
Lacey, Ben
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Shabnam, Sharmin
b337b72e-6dc4-4b56-b09a-ba11bc63a657
Erzurumluoglu, A. Mesut
a827b5ef-4687-4e33-8b50-fa9b3c9c748f
Dambha-Miller, Hajira
58961db5-31aa-460e-9394-08590c4b7ba1
Chowell, Gerardo
b6d48ad6-20f2-475a-a37d-91acef004d39
Kawachi, Ichiro
69fc5276-cd2a-42de-9012-f6ce38e9f636
Marmot, Michael
8a8336fb-93b4-42a9-8229-2ac070b3c215
1 June 2021
Islam, Md Nazrul
e5345196-7479-438f-b4f6-c372d2135586
Lacey, Ben
38227149-1faa-42d3-bf28-a9345d0c0872
Shabnam, Sharmin
b337b72e-6dc4-4b56-b09a-ba11bc63a657
Erzurumluoglu, A. Mesut
a827b5ef-4687-4e33-8b50-fa9b3c9c748f
Dambha-Miller, Hajira
58961db5-31aa-460e-9394-08590c4b7ba1
Chowell, Gerardo
b6d48ad6-20f2-475a-a37d-91acef004d39
Kawachi, Ichiro
69fc5276-cd2a-42de-9012-f6ce38e9f636
Marmot, Michael
8a8336fb-93b4-42a9-8229-2ac070b3c215
Islam, Md Nazrul, Lacey, Ben, Shabnam, Sharmin, Erzurumluoglu, A. Mesut, Dambha-Miller, Hajira, Chowell, Gerardo, Kawachi, Ichiro and Marmot, Michael
(2021)
Social inequality and the syndemic of chronic disease and COVID-19: County-level analysis in the USA.
Journal of Epidemiology & Community Health, 75 (6), .
(doi:10.1136/jech-2020-215626).
Abstract
Background: given the effect of chronic diseases on risk of severe COVID-19 infection, the present pandemic may have a particularly profound impact on socially disadvantaged counties.
Methods: counties in the USA were categorised into five groups by level of social vulnerability, using the Social Vulnerability Index (a widely used measure of social disadvantage) developed by the US Centers for Disease Control and Prevention. The incidence and mortality from COVID-19, and the prevalence of major chronic conditions were calculated relative to the least vulnerable quintile using Poisson regression models.
Results: among 3141 counties, there were 5 010 496 cases and 161 058 deaths from COVID-19 by 10 August 2020. Relative to the least vulnerable quintile, counties in the most vulnerable quintile had twice the rates of COVID-19 cases and deaths (rate ratios 2.11 (95% CI 1.97 to 2.26) and 2.42 (95% CI 2.22 to 2.64), respectively). Similarly, the prevalence of major chronic conditions was 24%–41% higher in the most vulnerable counties. Geographical clustering of counties with high COVID-19 mortality, high chronic disease prevalence and high social vulnerability was found, especially in southern USA.
Conclusion: some counties are experiencing a confluence of epidemics from COVID-19 and chronic diseases in the context of social disadvantage. Such counties are likely to require enhanced public health and social support.
Text
JECH_syndemics_covid_AuthorAcceptedVersion
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Accepted/In Press date: 16 December 2020
e-pub ahead of print date: 5 January 2021
Published date: 1 June 2021
Additional Information:
Funding Information:
Acknowledgements NI and BL receive salary support from the Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health (NDPH), University of Oxford. CTSU receives core support from the UK MRC, British Heart Foundation (BHF), and Cancer Research UK (CRUK). Support was also received from the US Centres for Disease Control and Prevention (CDC) Foundation (with support from Amgen). BL acknowledges support from UK Biobank, the National Institute for Health Research Biomedical Research Centre (Oxford, UK), and the BHF Centre of Research Excellence (Oxford, UK).
Publisher Copyright:
© Authors 2021
Keywords:
covid-19, inequality, Vulnerabilities
Identifiers
Local EPrints ID: 445707
URI: http://eprints.soton.ac.uk/id/eprint/445707
ISSN: 0143-005X
PURE UUID: cc48534a-d0c1-43d6-be0a-4958ffa50af4
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Date deposited: 06 Jan 2021 17:41
Last modified: 17 Mar 2024 06:12
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Contributors
Author:
Md Nazrul Islam
Author:
Ben Lacey
Author:
Sharmin Shabnam
Author:
A. Mesut Erzurumluoglu
Author:
Gerardo Chowell
Author:
Ichiro Kawachi
Author:
Michael Marmot
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