Socioeconomic Determinants of COVID-19 Incidence and Mortality in Florida.

Abstract

A wide variety of social determinants of health have been associated with various risks and impacts on quality of life. Specifically, poverty, lack of insurance coverage, large household sizes, and social vulnerability are all factors implicated in incidence and mortality rates of infectious disease. However, no studies have examined the relationship of these factors to the COVID-19 pandemic on a state-wide level in Florida. Thereby, the objective of this study is to examine the relationship between average household size, poverty, uninsured populations, social vulnerability index (SVI), and rates of COVID-19 cases and deaths in Florida counties.The objective was accomplished by analyzing the cumulative case and death reports from state and local health departments in Florida. The data was compiled into a single dataset by the CDC COVID-19 Task Force. Using US Census Bureau data, all Florida counties were classified into tertiles of the separate categories of poverty rate, average household size, uninsured rates, and SVI (Social Vulnerability Index). The poverty level was classified as low (0-12.3%), moderate (12.3-17.3%), and high (>17.3% below the federal poverty line). The uninsured population proportion was classified as low (0-7.1%), moderate (7.1-11.4%), and high (>11.4% uninsured residents). Average county household size was classified as low (0-2.4), moderate (2.4-2.6), and high (>2.6). The Centers for Disease Control and Prevention (CDC)/Agency for Toxic Substances and Disease Registry (ATSDR) Social Vulnerability Index (SVI) used US census data on 15 social determinants of vulnerability to evaluate and assist disadvantaged communities. SVI tertiles were low (0-0.333), moderate (0.334-0.666), and high (0.667-1) on a range of 0-1, with higher numbers signifying communities with many factors of social vulnerability. The mean cumulative cases and deaths per 100,000 inhabitants were calculated in each tertile for each category.Analysis of the data revealed that case and mortality rates due to COVID-19 in the high poverty counties were markedly higher in Florida than the national average. In contrast, moderate and low poverty rates were below average. Similarly, counties with a high SVI had case and mortality rates greatly above state and national averages. Counties with a high proportion of uninsured displayed the highest case rates. However, mortality rates were the highest in counties with a low proportion of uninsured individuals. No clear correlation was observed between COVID-19 rates and household size.It was concluded that compiled CDC and US census data suggests a significant correlation between poverty, social vulnerability, lack of insurance coverage, and increased incidence and mortality from COVID-19. Future research should statistically analyze the correlations and examine the individual factors of SVI as potential COVID-19 predictors.