2020年1月1日至2023年6月24日美国新冠死亡病例与少数族裔健康社会脆弱性

COVID-19 Deaths and Minority Health Social Vulnerability, in the U.S., January 1, 2020 through June 24, 2023.

作者信息

King Hope, Woolfork Makhabele Nolana, Yunyou Andrea, Edomwande Yuwa, Euler Erik, Almendares Olivia, Neupane Suresh Nath, Hagen Melissa Briggs

机构信息

Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases (NCIRD), Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA.

Centers for Disease Control and Prevention, 1600 Clifton Road NE, Bldg 24, Mailstop H24-9, Atlanta, GA, 30333, USA.

出版信息

J Racial Ethn Health Disparities. 2024 Oct 11. doi: 10.1007/s40615-024-02192-w.

DOI:10.1007/s40615-024-02192-w

PMID:39392568

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11985541/

Abstract

BACKGROUND

Health disparities, leading to worse health outcomes such as elevated COVID-19 mortality rates, are rooted in social and structural factors. These disparities notably impact individuals from lower socioeconomic backgrounds and more socially vulnerable areas. We analyzed the relationship between COVID-19 deaths and social vulnerability using the Minority Health Social Vulnerability Index (MHSVI).

METHODS

COVID-19 death data in the U.S. was obtained from the Centers for Disease Control and Prevention (CDC) National Center for Health Statistics, where COVID-19 deaths were defined using the ICD-10 code U07.1. MHSVI composite scores were calculated for 3089 U.S. counties and categorized into social vulnerability quartiles, where values ranged from 0 (lowest vulnerability) to 1 (highest vulnerability). Negative binomial regression was employed to determine death rate ratios for each quartile within each theme. Finally, a multivariate negative binomial regression including all MHSVI sub-themes, excluding the overall index ranking, was used to assess the association between each theme and COVID-19 death rates independently.

RESULTS

There were 1,134,272 COVID-19 deaths from January 1, 2020 through June 24, 2023. Adjusted rate ratios for COVID-19 deaths in the overall index ranking were 1.06 (95% CI 0.99-1.13), 1.14 (95% CI 1.06-1.22), and 1.41 (95% CI 1.31-1.52) for the second, third and fourth quartiles, respectively. Sub-themes of socioeconomic status (SES), household characteristics (HC), racial and ethnic minority status (REMS), housing type and transportation (HTT), and medical vulnerability (MV) revealed increasing death rates in higher vulnerability quartiles. The healthcare infrastructure and access (HIA) theme had decreasing death rate ratios of 0.74 (95% CI 0.71-0.78), 0.59 (95% CI 0.56-0.62), and 0.42 (95% CI 0.39-0.44) for the second, third, and fourth quartiles, respectively. Finally, the multivariate analysis showed that the HC, HTT, HIA, and MV themes were associated with COVID-19 deaths (P < 0.05).

CONCLUSION

Counties that were identified as more socially vulnerable experienced higher death rates from COVID-19. These areas may need additional public health and social support during future pandemics.

摘要

背景

健康差距导致了诸如新冠病毒19死亡率升高之类的更糟糕的健康结果，其根源在于社会和结构因素。这些差距尤其影响来自社会经济背景较低和社会弱势群体较多地区的个人。我们使用少数族裔健康社会脆弱性指数（MHSVI）分析了新冠病毒19死亡与社会脆弱性之间的关系。

方法

美国的新冠病毒19死亡数据来自疾病控制和预防中心（CDC）国家卫生统计中心，其中新冠病毒19死亡是使用国际疾病分类第十版代码U07.1定义的。计算了美国3089个县的MHSVI综合得分，并将其分为社会脆弱性四分位数，其值范围从0（最低脆弱性）到1（最高脆弱性）。采用负二项回归来确定每个主题内每个四分位数的死亡率比。最后，使用包括所有MHSVI子主题（不包括总体指数排名）的多变量负二项回归来独立评估每个主题与新冠病毒19死亡率之间的关联。

结果

从2020年1月1日到2023年6月24日，共有1134272例新冠病毒19死亡病例。总体指数排名中，新冠病毒19死亡的调整率比在第二、第三和第四四分位数中分别为1.06（95%置信区间0.99 - 1.13）、1.14（95%置信区间1.06 - 1.22）和1.41（95%置信区间1.31 - 1.52）。社会经济地位（SES）、家庭特征（HC）、种族和族裔少数群体地位（REMS）、住房类型和交通（HTT）以及医疗脆弱性（MV）等子主题显示，在脆弱性较高的四分位数中死亡率不断上升。医疗保健基础设施和可及性（HIA）主题在第二、第三和第四四分位数中的死亡率比分别为0.74（95%置信区间0.71 - 0.78）、0.59（95%置信区间0.56 - 0.62）和0.42（95%置信区间0.39 - 0.44），呈下降趋势。最后，多变量分析表明，HC、HTT、HIA和MV主题与新冠病毒19死亡相关（P < 0.05）。