Abstract 13425: Relationship Between Social Vulnerability and Case Fatality Rate at the Level of Counties and County-Equivalents in the Contiguous United States During the COVID-19 Pandemic

Abstract

Introduction: Pandemics prior to the COVID-19 pandemic have been known to disproportionately affect counties and county-equivalents with high social vulnerability. Social vulnerability refers to the potential negative effects on communities caused by external stresses on human health. Such stresses include natural or human-caused disasters, or disease outbreaks. On the other hand, case fatality rate estimates the proportion of deaths among identified confirmed cases. Hypothesis: A higher social vulnerability is associated with a higher case fatality rate at the levels of counties and county-equivalents in the contiguous United States during the COVID-19 pandemic. Methods: Data from 2990 counties and county-equivalents such as independent cities, districts, and parishes that are considered county-equivalents for census purposes was analyzed. Counties and county-equivalents from the non-contiguous states of Alaska and Hawaii were excluded as well as 59 counties and county-equivalents without available SVI data and/or available CFR data. Available SVI public source data was collected from the Centers for Disease Control and Prevention, while available CFR public source data was collected from the Emory Clinical Cardiovascular Research Institute. Results: Median SVI was 0.5185 [Range: 0.0006-1] and median CFR was 1.56% [Range: 0%-8.77%]. A vaccination rate ratio (RR) and 95% CI for SVI was calculated using Wald’s unconditional maximum likelihood estimation to compare CFRs of counties and county-equivalents with low social vulnerability (SVI: 0%-33%), moderate social vulnerability (33%-66%), and high social vulnerability (66%-100%). A higher SVI was associated with a higher CFR such that the RR for relative differences in CFR between counties and county-equivalents with a low social vulnerability and counties and county-equivalents with a high social vulnerability was 0.83, while the RR for relative differences in CFR between counties and county-equivalents with a moderate social vulnerability and counties and county-equivalents with a high social vulnerability was 0.89. Conclusions: Public policy interventions need to target counties and county-equivalents with a higher social vulnerability to help the most vulnerable of people.