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Social inequality, chronic disease and COVID-19: country level analysis in the United States

Social inequality, chronic disease and COVID-19: country level analysis in the United States
Social inequality, chronic disease and COVID-19: country level analysis in the United States
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
0143-005X
Islam, Nazrul
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Lacey, Ben
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Shabnam, Sharmin
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Erzurumluoglu, A. Mesut
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Dambha-Miller, Hajira
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Chowell, Gerardo
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Kawachi, Ichiro
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Marmot, Michael
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Islam, Nazrul
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Lacey, Ben
38227149-1faa-42d3-bf28-a9345d0c0872
Shabnam, Sharmin
b337b72e-6dc4-4b56-b09a-ba11bc63a657
Erzurumluoglu, A. Mesut
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Dambha-Miller, Hajira
58961db5-31aa-460e-9394-08590c4b7ba1
Chowell, Gerardo
b6d48ad6-20f2-475a-a37d-91acef004d39
Kawachi, Ichiro
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Marmot, Michael
8a8336fb-93b4-42a9-8229-2ac070b3c215

Islam, Nazrul, Lacey, Ben, Shabnam, Sharmin, Erzurumluoglu, A. Mesut, Dambha-Miller, Hajira, Chowell, Gerardo, Kawachi, Ichiro and Marmot, Michael (2021) Social inequality, chronic disease and COVID-19: country level analysis in the United States. Journal of Epidemiology & Community Health. (doi:10.1136/jech-2020-215626).

Record type: Article

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.

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More information

Accepted/In Press date: 16 December 2020
e-pub ahead of print date: 5 January 2021
Published date: 10 May 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
ORCID for Hajira Dambha-Miller: ORCID iD orcid.org/0000-0003-0175-443X

Catalogue record

Date deposited: 06 Jan 2021 17:41
Last modified: 13 Dec 2021 06:28

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Contributors

Author: 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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