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[Preprint]. 2020 Jul 14:2020.07.11.20151563.
doi: 10.1101/2020.07.11.20151563.

Identification of Vulnerable Populations and Areas at Higher Risk of COVID-19 Related Mortality in the U.S

Esteban Correa-Agudelo  1   2   3 , Tesfaye B Mersha  4 , Andrés Hernández  1   2   3 , Adam J Branscum  5 , Neil J MacKinnon  3   6 , Diego F Cuadros  1   2   3
Affiliations

Identification of Vulnerable Populations and Areas at Higher Risk of COVID-19 Related Mortality in the U.S

Esteban Correa-Agudelo et al. medRxiv. .

Update in

Abstract

Background: The role of health-related disparities including sociodemographic, environmental, and critical care capacity in the COVID-19 pandemic are poorly understood. In the present study, we characterized vulnerable populations located in areas at higher risk of COVID-19 related mortality and low critical healthcare capacity in the U.S.

Methods: Using Bayesian multilevel analysis and small area disease risk mapping, we assessed the spatial variation of COVID-19 related mortality risk for the U.S. in relation with healthcare disparities including race, ethnicity, poverty, air quality, and critical healthcare capacity.

Results: Overall, highly populated, regional air hub areas, and minorities had an increased risk of COVID-19 related mortality. We found that with an increase of only 1 ug/m3 in long term PM2.5 exposure, the COVID-19 mortality rate increased by 13%. Counties with major air hubs had 18% increase in COVID-19 related death compared to counties with no airport connectivity. Sixty-eight percent of the counties with high COVID-19 related mortality risk were also counties with lower critical care capacity than national average. These counties were primary located at the North- and South-Eastern regions of the country.

Conclusion: The existing disparity in health and environmental risk factors that exacerbate the COVID-19 related mortality, along with the regional healthcare capacity, determine the vulnerability of populations to COVID-19 related mortality. The results from this study can be used to guide the development of strategies for the identification and targeting preventive strategies in vulnerable populations with a higher proportion of minority groups living in areas with poor air quality and low healthcare capacity.

Keywords: COVID-19; air pollution; comorbidity; ethnicity; health disparities; healthcare capacity.

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Conflict of interest statement

CONFLICT OF INTEREST STATEMENT The authors declare no conflict of interest.

Figures

Figure 1.
Figure 1.
U.S. Relative Risk for COVID-19 by State
Figure 2.
Figure 2.
U.S. Relative Risk for COVID-19 by County, mean=0.53 (range is 0.01-14.37) (A). U.S. COVID-19 related relative risk (RR) of Death and ICU availability per 100,000, (without NY). Dark purple indicates counties with high ICU availability and low mortality risk whereas areas in darker green-blue indicate counties with high mortality risk but low ICU availability. Both variables were classified with a Tertile scheme as follows: COVID-19 related RR (0-1 lower risk, 1-3 medium risk, 3 > high risk), ICU beds per 100,000 (< 28.4 low availability, 28.4-100 medium availability, > 100 high availability) (B)
See this image and copyright information in PMC

References

    1. Richardson S, Hirsch JS, Narasimhan M, et al. Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area. JAMA. 2020.. - PMC - PubMed
    1. Williamson E, Walker AJ, Bhaskaran KJ, et al. OpenSAFELY: factors associated with COVID-19-related hospital death in the linked electronic health records of 17 million adult NHS patients. medRxiv. 2020:2020.2005.2006.20092999.
    1. Remuzzi A, Remuzzi G. COVID-19 and Italy: what next? The Lancet. 2020;395(10231):1225–1228. - PMC - PubMed
    1. Li R, Rivers C, Tan Q, Murray MB, Toner E, Lipsitch M. Estimated Demand for US Hospital Inpatient and Intensive Care Unit Beds for Patients With COVID-19 Based on Comparisons With Wuhan and Guangzhou, China. JAMA Network Open. 2020;3(5):e208297–e208297. - PMC - PubMed
    1. University JH. 2019 Novel Coronavirus COVID-19 (2019-nCoV) Data Repository by Johns Hopkins CSSE. https://github.com/CSSEGISandData/COVID-19. Accessed 06/07/2020, 2020.

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