The United States must address longstanding, deep-rooted social inequities if it wants to “bend the curve” on pandemic disparities, a new study suggests.
While the first surge was mainly in urban areas with high percentages of Black and Latino residents, as the pandemic raged on some of the highest rates of cases and deaths were in rural counties with predominantly white population.
“But across the board, we find the areas hardest-hit by the disease were linked by higher rates of social disadvantage,” Renuka Tipirneni, senior author of the study published in the latest edition of the journal JAMA Network Open, said in a statement.
That’s according to a county-level analysis of nearly 4.3 million coronavirus cases and more than 147,000 deaths.
University of Michigan researchers analyzed data from the Centers for Disease Control and Prevention’s Social Vulnerability Index or SVI, which ranks U.S. Census tracts on social factors such as socioeconomic status; housing; transportation; and race, ethnicity and language.
They used coronavirus incidence and mortality data collected between Jan. 20 and July 29, 2020.
Counties that had higher scores on this scale also had higher rates of COVID-19 incidence and mortality: A 0.1-point increase in SVI score was associated with a roughly 14% increase in COVID-19 incidence rate and a nearly 14% increase in mortality rate from the disease.
Put another way, a 0.1-point increase in a midsize metropolitan county corresponded with about 87 excess coronavirus cases and three excess deaths per 100,000 people.
“
‘While the first surge was mainly in urban areas with high percentages of Black and Latino residents, as time went on some of [the] highest rates of cases and deaths were in rural counties with predominantly white populations.’
”
Risk factors associated with COVID-19 cases and deaths included minority status, English-language proficiency, household composition, socioeconomic status and environmental factors, the study found.
The authors stressed that the virus wasn’t just a problem impacting “people of certain races/ethnicities or socioeconomic position living in certain cities” — rather, well-established inequities and their associated working and living conditions play a role regardless of where people live.
The pandemic’s crushing economic impacts, the authors added, are likely to worsen inequities in poverty, health-insurance coverage, food insecurity, unemployment and other social determinants of health. If left unaddressed, these factors could potentially kickstart “a vicious cycle” of rising virus transmission and continued COVID-19 inequities, they said.
SARS-CoV-2, the virus that causes the disease COVID-19, “neither created the conditions for health disparities nor did it reveal previously unrecognized social inequality” in the U.S., the article said.
Instead, it exacerbated entrenched inequities “to once again ensure that the most marginalized and under-resourced communities experience the worst outcomes.”
Much previous research has shed light on the virus’s disproportionate impact on people of color. CDC data show that Black, Hispanic and Native Americans are between two and four times as likely as white Americans to be hospitalized or die from COVID-19.
But as at least one other study pointed out, Black and Hispanic populations aren’t “inherently more susceptible” to poor COVID-19 outcomes. Structural determinants of health, such as housing, health-care access and differential employment opportunities, appear to drive those disparities.
As of Monday, COVID-19 had infected at least 26.2 million people in the U.S. and killed 441,454 people, according to data aggregated by Johns Hopkins University. The global case tally stood at 103.1 million and global deaths were 2.2 million, with the U.S. continuing to lead in both metrics.
