Area-Level Social Vulnerability and Severe Covid-19

A Case–Control Study Using Electronic Health Records from Multiple Health Systems in the Southeastern Pennsylvania Region

Bibliographic Data

ID12474240
AuthorsPricila H Mullachery (0000-0003-4758-3875, Temple University, corresponding author), Usama Bilal (0000-0002-9868-7773, Drexel University), Ran Li (0000-0002-4699-4755, Drexel University), Leslie A McClure (0000-0002-2465-6739, Drexel University)
Year2024
Volume101
Issue4
Pages845-855
Publication date2024-05-13
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueJournal of Urban Health (JOURNAL)
Journal identifiersISSN: 1099-3460 • E-ISSN: 1468-2869
PublisherSpringer Science+Business Media (PUBLISHER • DE)
DOI10.1007/s11524-024-00876-6
PMID38740710
OpenAlexW4396852564
LanguageEN
References cited44

Knowledge about neighborhood characteristics that predict disease burden can be used to guide equity-based public health interventions or targeted social services. We used a case-control design to examine the association between area-level social vulnerability and severe COVID-19 using electronic health records (EHR) from a regional health information hub in the greater Philadelphia region. Severe COVID-19 cases (n = 15,464 unique patients) were defined as those with an inpatient admission and a diagnosis of COVID-19 in 2020. Controls (n = 78,600; 5:1 control-case ratio) were a random sample of individuals who did not have a COVID-19 diagnosis from the same geographic area. Retrospective data on comorbidities and demographic variables were extracted from EHR and linked to area-level social vulnerability index (SVI) data using ZIP codes. Models adjusted for different sets of covariates showed incidence rate ratios (IRR) ranging from 1.15 (95% CI, 1.13-1.17) in the model adjusted for individual-level age, sex, and marital status to 1.09 (95% CI, 1.08-1.11) in the fully adjusted model, which included individual-level comorbidities and race/ethnicity. The fully adjusted model indicates that a 10% higher area-level SVI was associated with a 9% higher risk of severe COVID-19. Individuals in neighborhoods with high social vulnerability were more likely to have severe COVID-19 after accounting for comorbidities and demographic characteristics. Our findings support initiatives incorporating neighborhood-level social determinants of health when planning interventions and allocating resources to mitigate epidemic respiratory diseases, including other coronavirus or influenza viruses

Environmental health · Health equity · Marital status · Population · Psychiatry · Psychological intervention · Public health · Social vulnerability · Vulnerability (computing · Computer Science · Demography · Employment and Welfare Studies · Food Security and Health in Diverse Populations · Health disparities and outcomes · Medicine · Gerontology

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