Differences in COVID-19 Risk by Race and County-Level Social Determinants of Health among Veterans
Abstract
:1. Introduction
2. Materials and Methods
Statistical Analysis
3. Results
4. Discussion
Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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n (%) | All (n = 778,599) | White (n = 526,480) | Black n = 186,373 | Other (n = 65,746) |
---|---|---|---|---|
SARS-CoV-2 Test Result | ||||
Negative | 700,907 (90.0) | 476,642 (90.5) | 165,708 (88.9) | 58,557 (89.1) |
Positive | 77,692 (10.0) | 49,838 (9.5) | 20,665 (11.1) | 7189 (10.9) |
Sex | ||||
Male | 691,365 (88.8) | 477,006 (90.6) | 157,087 (84.3) | 57,272 (87.1) |
Female | 87,234 (11.2) | 49,474 (9.4) | 29,286 (15.7) | 8474 (12.9) |
Age | ||||
18–34 | 52,308 (6.7) | 34,901 (6.6) | 10,309 (5.5) | 7098 (10.8) |
35–44 | 78,661 (10.1) | 51,726 (9.8) | 17,560 (9.4) | 9375 (14.3) |
45–54 | 97,506 (12.5) | 59,319 (11.3) | 28,597 (15.3) | 9590 (14.6) |
55–64 | 164,301 (21.1) | 96,631 (18.4) | 54,890 (29.5) | 12,780 (19.4) |
65–74 | 248,054 (31.9) | 177,486 (33.7) | 53,397 (28.7) | 17,171 (26.1) |
75+ | 137,769 (17.7) | 106,417 (20.2) | 21,620 (11.6) | 9732 (14.8) |
Race | ||||
White | 526,480 (67.6) | -- | -- | -- |
Black/African American | 186,373 (23.9) | -- | -- | -- |
Asian | 9665 (1.2) | -- | -- | 9665 (14.7) |
American Indian/Alaska Native | 7485 (1.0) | -- | -- | 7485 (11.4) |
Pacific Islander/Native Hawaiian | 6874 (0.9) | -- | -- | 6874 (10.5) |
Unknown/Missing | 41,722 (5.4) | -- | -- | 41,722 (63.5) |
Ethnicity | ||||
Hispanic or Latino | 57,801 (7.4) | 40,944 (7.8) | 3329 (1.8) | 13,528 (20.6) |
Not Hispanic or Latino | 703,052 (90.3) | 480,900 (91.3) | 181,434 (97.3) | 40,718 (61.9) |
Unknown | 17,746 (2.3) | 4636 (0.9) | 1610 (0.9) | 11,500 (17.5) |
Marital Status | ||||
Single | 130,442 (16.8) | 76,932 (14.6) | 40,493 (21.7) | 13,017 (19.8) |
Married | 365,781 (47.0) | 264,479 (50.2) | 69,966 (37.5) | 31,336 (47.7) |
Divorced/Separated/Widowed | 273,214 (35.1) | 180,150 (34.2) | 74,048 (39.7) | 19,016 (28.9) |
Urban/Rural | ||||
Urban | 573,072 (73.6) | 355,834 (67.6) | 164,582 (88.3) | 52,656 (80.1) |
Rural | 205,527 (26.4) | 170,646 (32.4) | 21,791 (11.7) | 13,090 (19.9) |
Region | ||||
Continental | 114,974 (14.8) | 75,113 (14.3) | 30,589 (16.4) | 9272 (14.1) |
Midwest | 160,422 (20.6) | 121,541 (23.1) | 29,694 (15.9) | 9187 (14.0) |
Northeast | 184,049 (23.6) | 119,302 (22.7) | 54,442 (29.2) | 10,305 (15.7) |
Pacific | 155,350 (20.0) | 105,629 (20.1) | 22,431 (12.0) | 27,290 (41.5) |
Southeast | 163,804 (21.0) | 104,895 (19.9) | 49,217 (26.4) | 9692 (14.7) |
Priority Group a | ||||
No Service Disability | 89,103 (11.4) | 62,920 (12.0) | 18,647 (10.0) | 7536 (11.5) |
Low Income | 154,047 (19.8) | 105,635 (20.1) | 37,995 (20.4) | 10,417 (15.8) |
Low/Moderate Disability | 151,646 (19.5) | 108,431 (20.6) | 30,684 (16.5) | 12,531 (19.1) |
High Disability | 383,803 (49.3) | 249,494 (47.4) | 99,047 (53.1) | 35,262 (53.6) |
Median (P25–P75) | All (n = 778,599) | White (n = 526,480) | Black n = 186,373 | Other (n = 65,746) |
Percentage without High School Diploma, Ages 25+ | 11.8 (9.3–14.7) | 11.4 (9.0–14.4) | 12.4 (9.7–15.5) | 12.6 (9.7–16.3) |
Percentage without 4+ Years College, Ages 25+ | 69.9 (65.1–77.8) | 70.6 (65.6–78.9) | 68.8 (62.8–75.7) | 69.1 (64.0–77.2) |
Percentage Food Stamps/SNAP Recipients | 14.6 (10.8–18.3) | 14.1 (10.3–17.2) | 15.8 (12.3–20.4) | 13.7 (9.7–17.9) |
Percentage without Health Insurance, Under Age 65 | 9.7 (6.6–12.8) | 9.4 (6.3–12.6) | 10.7 (7.9–13.0) | 9.6 (7.1–12.7) |
Percentage Eligible for Medicaid, All Ages, 2012 | 22.9 (18.0–27.3) | 22.5 (17.7–26.2) | 23.6 (19.4–28.7) | 24.4 (18.9–28.9) |
Percentage in Crowded Housing | 2.36 (1.6–3.8) | 2.22 (1.5–3.5) | 2.46 (1.71–3.81) | 3.6 (2.01–6.54) |
Percentage 65+ living alone | 10.8 (9.0–12.3) | 11.0 (9.1–12.6) | 10.3 (8.8–11.6) | 9.6 (8.8–11.5) |
Percentage of Households without a computer | 10.7 (8.4–14.1) | 10.8 (8.5–14.2) | 10.7 (8.5–14.2) | 9.6 (7.5–12.3) |
Percentage of households without broadband | 19.1 (15.6–23.5) | 19.2 (15.6–23.6) | 19.5 (16.1–23.7) | 17.9 (14.4–21.8) |
Percentage Non-US-born residents | 8.6 (4.5–16.7) | 7.7 (3.8–14.9) | 9.8 (5.6–21.1) | 13.3 (6.6–23.3) |
Percentage Non-White | 36.2 (19.9–54.9) | 28.6 (15.2–47.6) | 50.7 (36.24–63.36) | 49.7 (28.2–63.9) |
Median Household Income (thousands) | 54.5 (47.6–62.4) | 54.5 (47.6–62.3) | 54.4 (46.7–61.6) | 57.6 (50.3–68.9) |
Unemployment Rate Ages 16+, 2017 | 4.1 (3.6–4.7) | 4.0 (3.5–4.7) | 4.3 (3.7–4.9) | 4.0 (3.5–4.7) |
Percentage of households where grandparent have children under 18 | 5.9 (4.5–7.3) | 5.52 (4.3–7.2) | 6.4 (4.97–7.51) | 6.75 (5.0–8.5) |
Percentage Persons 65+ in Deep Poverty | 2.8 (2.3–3.4) | 2.7 (2.2–3.3) | 3.1 (2.5–3.6) | 3.0 (2.4–3.4) |
Percentage of Persons in Deep Poverty | 6.7 (5.2–7.7) | 6.5 (5.0–7.5) | 7.2 (6.0–8.7) | 6.8 (5.3–7.5) |
All (n = 778,599) | White (n = 526,480) | Black (n = 186,373) | Other (n = 65,746) | ||||||
---|---|---|---|---|---|---|---|---|---|
Percentage of Persons in Deep Poverty | 3.5–11.2 | REF | -- | REF | -- | REF | -- | REF | -- |
>11.2–14.7 | 0.96 | [0.89, 1.02] | 0.97 | [0.90, 1.04] | 0.88 | [0.79, 0.98] | 0.96 | [0.84, 1.10] | |
>14.7–17.0 | 0.94 | [0.86, 1.03] | 0.95 | [0.87, 1.05] | 0.89 | [0.78, 1.01] | 0.89 | [0.76, 1.04] | |
>17.0–48.6 | 0.94 | [0.83, 1.05] | 0.96 | [0.84, 1.09] | 0.87 | [0.73, 1.03] | 0.87 | [0.72, 1.04] | |
Percentage without 4+ Years College, Ages 25+ | 21.9–65.1 | REF | -- | REF | -- | REF | -- | REF | -- |
>65.1–69.9 | 1.14 | [1.08, 1.22] | 1.19 | [1.12, 1.26] | 1.06 | [0.98, 1.14] | 1.08 | [0.95, 1.23] | |
>69.9–77.8 | 1.12 | [1.04, 1.21] | 1.16 | [1.07, 1.26] | 1.02 | [0.93, 1.12] | 1.12 | [0.98, 1.28] | |
>77.8–95.1 | 1.23 | [1.10, 1.37] | 1.24 | [1.11, 1.38] | 1.14 | [0.99, 1.31] | 1.31 | [1.09, 1.59] | |
Percentage Food Stamps/SNAP Recipients | 0.4–10.8 | REF | -- | REF | -- | REF | -- | REF | -- |
>10.8–14.6 | 1.01 | [0.94, 1.09] | 1.00 | [0.92, 1.09] | 1.05 | [0.96, 1.15] | 1.06 | [0.96, 1.18] | |
>14.6–18.3 | 1.07 | [0.99, 1.16] | 1.05 | [0.96, 1.15] | 1.10 | [0.98, 1.24] | 1.08 | [0.94, 1.24] | |
>18.3–57.3 | 1.06 | [0.95, 1.18] | 1.06 | [0.94, 1.21] | 0.97 | [0.83, 1.13] | 1.18 | [0.98, 1.43] | |
Percentage without Health Insurance, Under Age 65 | 2.1–6.5 | REF | -- | REF | -- | REF | -- | REF | -- |
>6.5–9.7 | 0.97 | [0.92, 1.02] | 0.95 | [0.86, 1.04] | 0.99 | [0.92, 1.07] | 0.86 | [0.76, 0.99] | |
>9.7–12.8 | 0.92 | [0.86, 0.98] | 0.84 | [0.68, 1.04] | 1.04 | [0.90, 1.21] | 0.79 | [0.69, 0.92] | |
>12.8–31.1 | 0.94 | [0.84, 1.06] | 0.71 | [0.46, 1.10] | 1.21 | [1.00, 1.47] | 0.77 | [0.65, 0.91] | |
Percentage Eligible for Medicaid | 0.6–18.0 | REF | -- | REF | -- | REF | -- | REF | -- |
>18.0–22.9 | 1.04 | [0.97, 1.11] | 1.01 | [0.94, 1.01] | 1.06 | [0.99, 1.14] | 1.12 | [1.00, 1.24] | |
>22.9–27.3 | 1.08 | [0.99, 1.22] | 1.07 | [0.97, 1.17] | 1.10 | [0.99, 1.22] | 1.11 | [0.99, 1.25] | |
>27.3–62.0 | 1.17 | [1.05, 1.37] | 1.16 | [1.02, 1.32] | 1.20 | [1.05, 1.37] | 1.21 | [1.03, 1.44] | |
Percentage in Crowded Housing | 0.0–1.6 | REF | -- | REF | -- | REF | -- | REF | -- |
>1.6–2.4 | 1.01 | [0.96, 1.07] | 0.99 | [0.94, 1.06] | 1.04 | [0.98, 1.10] | 1.01 | [0.91, 1.13] | |
>2.4–3.8 | 1.10 | [1.04, 1.17] | 1.11 | [1.03, 1.19] | 1.07 | [1.00, 1.15] | 1.08 | [0.95, 1.21] | |
>3.8–34.9 | 1.07 | [0.99, 1.17] | 1.10 | [0.99, 1.21] | 0.99 | [0.88, 1.11] | 1.12 | [0.93, 1.34] | |
Percentage 65+ living alone | 2.8–9.0 | REF | -- | REF | -- | REF | -- | REF | -- |
>9.0–10.8 | 0.97 | [0.92, 1.03] | 2.13 | [0.79, 5.73] | 0.93 | [0.84, 1.03] | 0.95 | [0.88, 1.03] | |
>10.8–12.3 | 0.98 | [0.91, 1.05] | 2.21 | [0.76, 6.44] | 0.97 | [0.81, 1.15] | 1.01 | [0.92, 1.10] | |
>12.3–31.8 | 0.94 | [0.87, 1.02] | 2.18 | [0.76, 6.25] | 0.93 | [0.78, 1.09] | 0.90 | [0.82, 0.99] | |
Percentage Without Computer | 1.4–8.4 | REF | -- | REF | -- | REF | -- | REF | -- |
>8.4–10.7 | 1.04 | [0.97, 1.13] | 1.08 | [0.99, 1.18] | 0.98 | [0.93, 1.05] | 1.07 | [0.94, 1.22] | |
>10.7–14.1 | 1.06 | [0.96, 1.18] | 1.09 | [0.96, 1.23] | 1.07 | [0.97, 1.17] | 1.09 | [0.90, 1.32] | |
>14.1–61.7 | 1.05 | [0.93, 1.19] | 1.08 | [0.94, 1.24] | 1.06 | [0.92, 1.21] | 1.09 | [0.86, 1.37] | |
Percentage Without Broadband Internet | 6.0–15.6 | REF | -- | REF | -- | REF | -- | REF | -- |
>15.6–19.1 | 1.04 | [0.97, 1.12] | 1.02 | [0.94, 1.10] | 1.06 | [0.97, 1.15] | 1.05 | [0.91, 1.21] | |
>19.1–23.5 | 1.02 | [0.92, 1.13] | 0.99 | [0.88, 1.11] | 1.07 | [0.94, 1.21] | 0.97 | [0.80, 1.17] | |
>23.5–74.3 | 1.03 | [0.92, 1.16] | 1.01 | [0.88, 1.14] | 1.06 | [0.93, 1.21] | 0.91 | [0.72, 1.16] | |
Percentage Non-US-born residents | 0.0–4.5 | REF | -- | REF | -- | REF | -- | REF | -- |
>4.5–8.6 | 1.02 | [0.96, 1.07] | 1.01 | [0.95, 1.07] | 1.06 | [0.98, 1.15] | 0.94 | [0.84, 1.06] | |
>8.6–16.7 | 1.01 | [0.94, 1.10] | 0.99 | [0.91, 1.08] | 1.07 | [0.96, 1.19] | 0.99 | [0.86, 1.14] | |
>16.7–53.3 | 1.15 | [1.03, 1.29] | 1.12 | [1.00, 1.25] | 1.14 | [0.98, 1.32] | 1.19 | [0.99, 1.43] | |
Percentage Non-White | 1.7–19.5 | REF | -- | REF | -- | REF | -- | REF | -- |
>19.5–36.2 | 1.04 | [0.98, 1.11] | 1.07 | [1.00, 1.14] | 1.05 | [0.94, 1.17] | 1.03 | [0.93, 1.15] | |
>36.2–55.0 | 1.01 | [0.92, 1.10] | 1.01 | [0.92, 1.10] | 1.09 | [0.97, 1.22] | 0.98 | [0.83, 1.16] | |
>55.0–97.2 | 1.11 | [0.99, 1.24] | 1.08 | [0.95, 1.22] | 1.16 | [1.01, 1.33] | 1.13 | [0.92, 1.38] | |
Median Household Income (thousands) | 22.0–47.6 | REF | -- | REF | -- | REF | -- | REF | -- |
>47.6–54.5 | 0.97 | [0.91, 1.03] | 0.98 | [0.91, 1.05] | 0.94 | [0.87, 1.01] | 0.94 | [0.83, 1.07] | |
>54.5–62.4 | 1.05 | [0.98, 1.13] | 1.04 | [0.95, 1.14] | 1.06 | [0.95, 1.18] | 0.99 | [0.85, 1.16] | |
>62.4–134.6 | 1.03 | [0.91, 1.17] | 1.01 | [0.88, 1.17] | 1.03 | [0.90, 1.18] | 0.95 | [0.78, 1.15] | |
Unemployment Rate Ages 16+, 2017 | 1.3–3.6 | REF | -- | REF | -- | REF | -- | REF | -- |
>3.6–4.1 | 1.02 | [0.97, 1.07] | 0.81 | [0.63, 1.03] | 0.99 | [0.91, 1.08] | 1.03 | [0.97, 1.10] | |
>4.1–4.7 | 0.98 | [0.92, 1.04] | 0.87 | [0.67, 1.13] | 0.93 | [0.85, 1.02] | 0.98 | [0.90, 1.07] | |
>4.7–20.5 | 0.93 | [0.86, 1.01] | 0.77 | [0.56, 1.06] | 0.86 | [0.78, 0.94] | 0.96 | [0.85, 1.09] | |
Percentage of households where grandparents have children under 18 | 0.0–4.5 | REF | -- | REF | -- | REF | -- | REF | -- |
>4.5–5.9 | 1.06 | [1.00, 1.12] | 1.07 | [1.00, 1.13] | 1.10 | [1.03, 1.19] | 0.95 | [0.85, 1.06] | |
>5.9–7.3 | 1.05 | [0.98, 1.12] | 1.05 | [0.97, 1.13] | 1.17 | [1.08, 1.28] | 0.93 | [0.81, 1.06] | |
>7.3–32.4 | 1.01 | [0.93, 1.08] | 1.01 | [0.93, 1.10] | 1.14 | [1.04, 1.25] | 0.89 | [0.76, 1.05] |
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Abdel Magid, H.S.; Ferguson, J.M.; Van Cleve, R.; Purnell, A.L.; Osborne, T.F. Differences in COVID-19 Risk by Race and County-Level Social Determinants of Health among Veterans. Int. J. Environ. Res. Public Health 2021, 18, 13140. https://doi.org/10.3390/ijerph182413140
Abdel Magid HS, Ferguson JM, Van Cleve R, Purnell AL, Osborne TF. Differences in COVID-19 Risk by Race and County-Level Social Determinants of Health among Veterans. International Journal of Environmental Research and Public Health. 2021; 18(24):13140. https://doi.org/10.3390/ijerph182413140
Chicago/Turabian StyleAbdel Magid, Hoda S., Jacqueline M. Ferguson, Raymond Van Cleve, Amanda L. Purnell, and Thomas F. Osborne. 2021. "Differences in COVID-19 Risk by Race and County-Level Social Determinants of Health among Veterans" International Journal of Environmental Research and Public Health 18, no. 24: 13140. https://doi.org/10.3390/ijerph182413140
APA StyleAbdel Magid, H. S., Ferguson, J. M., Van Cleve, R., Purnell, A. L., & Osborne, T. F. (2021). Differences in COVID-19 Risk by Race and County-Level Social Determinants of Health among Veterans. International Journal of Environmental Research and Public Health, 18(24), 13140. https://doi.org/10.3390/ijerph182413140