Mediation of Latinx health status disparities during the COVID-19 pandemic by social determinants of health.

PURPOSE

The hypothesis that health status disparities exist because of high levels of social disadvantages, the Social Determinants of Health - Health Disparities (SDOH-HD) hypothesis by Ramírez García [1], was investigated among adults (N = 1,833) attending SARS-CoV-2 testing events at 71 community sites.

METHODS

A Multilevel Structural Equation Model (CFI = 1.0, SRMRs ≤ 0.03), with cross-sectional self-reported data, operationalized health status with latent individual level and latent community site level variables. At the individual level, health variables met full or partial metric equivalence between participants who answered the survey in Spanish versus in English (CFIs = 0.99, SRMRs ≤ 0.03).

RESULTS

Consistent with the SDOH-HD, high food insecurity and/or low levels of education among Latinxs putatively mediated (abs = 0.01 to 0.08, ps < 0.05) worse individual level general health (Within Level Model R = 0.10, p <.05) or worse individual level psychological distress (Within Level Model R = 0.11, p <.05) compared to non-Latinx Whites. However, three SDOH - unemployment, housing instability, and discrimination - did not support the SDOH-HD. Community site level SDOH - social vulnerability, and minority status indices - were not significantly related to site level health status, but site level psychological distress was lower in rural than in urban sites (γ = - 0.39, p <.05).

CONCLUSION

Taken together, the results delineate that equitable implementation of food security and education interventions may mitigate health status Latinx disparities. The SDOH-HD was partially supported, underscoring the need to investigate further these and additional SDOH-HD pathways.