Islam Nazrul, Lacey Ben, Shabnam Sharmin, Erzurumluoglu A Mesut, Dambha-Miller Hajira, Chowell Gerardo, Kawachi Ichiro, Marmot Michael
Nuffield Department of Population Health, University of Oxford, Oxford, Oxfordshire, UK
MRC Epidemiology Unit, University of Cambridge, Cambridge, UK.
J Epidemiol Community Health. 2021 Jan 5. doi: 10.1136/jech-2020-215626.
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.
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.
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.
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.
鉴于慢性病对严重新冠病毒感染风险的影响，当前的疫情可能对社会弱势群体聚居的县产生尤为深远的影响。
利用美国疾病控制与预防中心制定的社会脆弱性指数（一种广泛使用的社会弱势群体衡量指标），将美国各县按社会脆弱程度分为五组。使用泊松回归模型，以最不易受影响的五分位数为参照，计算新冠病毒感染的发病率、死亡率以及主要慢性病的患病率。
截至2020年8月10日，在3141个县中，有5010496例新冠病毒感染病例，161058人死亡。与最不易受影响的五分位数相比，最易受影响的五分位数中的县的新冠病毒感染病例和死亡发生率是其两倍（发病率比值分别为2.11（95%置信区间1.97至2.26）和2.42（95%置信区间2.22至2.64））。同样，最易受影响的县的主要慢性病患病率要高出24% - 41%。发现新冠病毒高死亡率、高慢性病患病率和高社会脆弱性的县在地理上存在聚集现象，尤其是在美国南部。
在社会弱势群体聚居的背景下，一些县正经历新冠病毒感染和慢性病两种疫情的汇聚。这些县可能需要加强公共卫生和社会支持。
