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. 2021 Apr 12;18(8):4021.
doi: 10.3390/ijerph18084021.

Identification of Vulnerable Populations and Areas at Higher Risk of COVID-19-Related Mortality during the Early Stage of the Epidemic in the United States

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

Identification of Vulnerable Populations and Areas at Higher Risk of COVID-19-Related Mortality during the Early Stage of the Epidemic in the United States

Esteban Correa-Agudelo et al. Int J Environ Res Public Health. .

Abstract

We characterized vulnerable populations located in areas at higher risk of COVID-19-related mortality and low critical healthcare capacity during the early stage of the epidemic in the United States. We analyze data obtained from a Johns Hopkins University COVID-19 database to assess the county-level spatial variation of COVID-19-related mortality risk during the early stage of the epidemic in relation to health determinants and health infrastructure. Overall, we identified highly populated and polluted areas, regional air hub areas, race minorities (non-white population), and Hispanic or Latino population with an increased risk of COVID-19-related death during the first phase of the epidemic. The 10 highest COVID-19 mortality risk areas in highly populated counties had on average a lower proportion of white population (48.0%) and higher proportions of black population (18.7%) and other races (33.3%) compared to the national averages of 83.0%, 9.1%, and 7.9%, respectively. The Hispanic and Latino population proportion was higher in these 10 counties (29.3%, compared to the national average of 9.3%). Counties with major air hubs had a 31% increase in mortality risk compared to counties with no airport connectivity. Sixty-eight percent of the counties with high COVID-19-related mortality risk also had lower critical care capacity than the national average. The disparity in health and environmental risk factors might have exacerbated the COVID-19-related mortality risk in vulnerable groups during the early stage of the epidemic.

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

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Relative risk for Coronavirus Disease 2019 (COVID-19) mortality rates by state.
Figure 2
Figure 2
U.S. Relative Risk for COVID-19 mortality by county, mean = 0.63 (CrI range is 0.00–14.8) (a). U.S. COVID-19-related relative risk (RR) of death and (b) COVID-19 spatial effect.
Figure 3
Figure 3
Intensive care units (ICU) bed availability per 100,000 (ICU information was not available in AK and HI). 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, and 3 > high risk) and ICU beds per 100,000 (<28.4 low availability, 28.4–100 medium availability, and >100 high availability).
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