Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, VA, USA; Center for Health Policy, University of Virginia, Charlottesville, VA, USA.
Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, VA, USA; Center for Health Policy, University of Virginia, Charlottesville, VA, USA.
Public Health. 2020 Dec;189:129-134. doi: 10.1016/j.puhe.2020.09.016. Epub 2020 Oct 17.
The United States has the highest number of coronavirus disease 2019 (COVID-19) in the world, with high variability in cases and mortality between communities. We aimed to quantify the associations between socio-economic status and COVID-19-related cases and mortality in the U.S.
The study design includes nationwide COVID-19 data at the county level that were paired with the Distressed Communities Index (DCI) and its component metrics of socio-economic status.
Severely distressed communities were classified by DCI>75 for univariate analyses. Adjusted rate ratios were calculated for cases and fatalities per 100,000 persons using hierarchical linear mixed models.
This cohort included 1,089,999 cases and 62,298 deaths in 3127 counties for a case fatality rate of 5.7%. Severely distressed counties had significantly fewer deaths from COVID-19 but higher number of deaths per 100,000 persons. In risk-adjusted analysis, the two socio-economic determinants of health with the strongest association with both higher cases per 100,000 persons and higher fatalities per 100,000 persons were the percentage of adults without a high school degree (cases: RR 1.10; fatalities: RR 1.08) and proportion of black residents (cases and fatalities: Relative risk(RR) 1.03). The percentage of the population aged older than 65 years was also highly predictive for fatalities per 100,000 persons (RR 1.07).
Lower education levels and greater percentages of black residents are strongly associated with higher rates of both COVID-19 cases and fatalities. Socio-economic factors should be considered when implementing public health interventions to ameliorate the disparities in the impact of COVID-19 on distressed communities.
美国是全球冠状病毒病 2019（COVID-19）病例最多的国家，社区之间的病例和死亡率差异很大。我们旨在量化社会经济地位与美国 COVID-19 相关病例和死亡率之间的关联。
本研究设计包括全国范围内县级 COVID-19 数据，这些数据与困境社区指数（DCI）及其社会经济地位的组成指标相匹配。
通过 DCI>75 对严重困境社区进行分类。使用分层线性混合模型计算每 10 万人的病例和死亡人数的调整率比。
该队列包括 3127 个县的 1,089,999 例病例和 62,298 例死亡，病死率为 5.7%。严重困境县 COVID-19 死亡人数明显较少，但每 10 万人死亡人数较多。在风险调整分析中，与每 10 万人的病例数和死亡数均呈最强关联的两个健康社会决定因素是未完成高中学业的成年人比例（病例：RR1.10；死亡：RR1.08）和黑人居民比例（病例和死亡：相对风险[RR]1.03）。65 岁以上人口比例也高度预测每 10 万人的死亡人数（RR1.07）。
较低的教育水平和较高的黑人居民比例与 COVID-19 病例和死亡人数的增加密切相关。在实施公共卫生干预措施以减轻 COVID-19 对困境社区影响的差异时，应考虑社会经济因素。
