Association of Social Vulnerability and COVID-19 Mortality Rates in Texas between 15 March 2020, and 21 July 2022: An Ecological Analysis
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Study Population
2.2. Study Variables and Data Sources
Data | Year | Source |
---|---|---|
Outcomes | ||
Mortality | July 2021–July 2022 | COVID-19 Cases and Deaths by Vaccination Status Dashboard [33]. |
Exposures | ||
Minority Health Social Vulnerability Index (MH SVI) | 2018 (Modified July 2021) | Minority Health Social Vulnerability Index [24]. |
Covariates | ||
Population Density | 2019 | County Population Totals: 2010–2019 [34]. |
Urbanicity | 2020 | Economic Research Service USA Department of Agriculture (ERS-USDA) [35]. |
Percentage of Adult Smokers in the County | 2019 | County Rankings. Smoking [36] |
County Mean Life Expectancy | 2018–2020 | County Rankings. Life expectancy [36]. |
Percentage of Females per County (Gender) | 2018 | County Population [34]. |
Average Particulate Matter (PM)2.5 | 2020 | County ranking. Average particulate matter [36] |
Percentage of Residents Fully Vaccinated Against COVID-19 | 2020–2022 | COVID-19 Cases and Deaths by Vaccination Status Dashboard [33]. |
Political Affiliations (2020 Presidential Voting Patterns per County) | 2020 | MIT Election Data Lab [37]. |
County’s Median Age | 2019 | USA Census Bureau [34]. |
2.3. Statistical Analysis
3. Results
3.1. Descriptive Characteristics of Sample
3.2. Descriptive Bivariate Map of County-Level MH SVI and COVID-19 Mortality Rates in Texas
3.3. Associations between the Covariates and COVID-19 Mortality Rates in Texas
3.4. Associations between MH SVI and Components with COVID-19 Mortality in Texas
3.5. Association of MH SVI Subcomponents and COVID-19 Mortality Rates in Texas
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Variable (n = 254) | Mean | Standard Deviation (±) | Median | Range |
---|---|---|---|---|
COVID-19 Mortality per 100,000 Population | 470.83 | 170.35 | 463.14 | 0.00–1211.31 |
Composite/Overall MH SVI | ||||
Socioeconomic Status | ||||
% of Persons Living Below Poverty | 16.05 | 6.07 | 15.20 | 2.60–39.50 |
% of Civilians Aged 16+ Unemployed | 5.62 | 2.81 | 5.40 | 0.00–17.90 |
Income Per Capita | 25,497.25 | 5292.63 | 25,128.5 0 | 13,350.00–43,439.00 |
% of Persons Aged 25+ with No High School Diploma | 19.48 | 8.27 | 17.8 | 6.30–66.3 |
Household Composition/ Disability | ||||
% of Persons Aged 65 and Older | 17.53 | 5.31 | 16.80 | 8.60–35.9 |
% of Persons Aged 17 and Younger | 24.35 | 3.96 | 24.10 | 12.80–36.60 |
% of Civilian Noninstitutionalized Population with a Disability | 16.08 | 4.54 | 15.75 | 5.3–31.00 |
% of Single Parent Household with Children Under 18 | 8.07 | 3.08 | 8.5 | 0–22.70 |
Minority Status/Language | ||||
% of American Indian/Alaska Native | 0.57 | 0.56 | 0.40 | 0.00–3.40 |
% of Asian | 1.09 | 2.01 | 0.55 | 0.00–19.90 |
% of African American | 6.34 | 6.60 | 4.15 | 0.00–33.80 |
% of Native Hawaiian/Pacific Islander | 0.06 | 0.14 | 0.00 | 0.00–1.10 |
% of Hispanic or Latinx | 34.83 | 23.27 | 26.55 | 3.50–99.1 |
% of Some Other Race | 5.77 | 7.99 | 3.22 | 0.00–57.01 |
% of Spanish Speakers * | 9.21 | 8.33 | 6.76 | 0.00–51.36 |
% of Chinese Speakers * | 0.07 | 0.20 | 0.00 | 0.00–1.79 |
% of Vietnamese Speakers * | 0.09 | 0.21 | 0.00 | 0.00–1.32 |
% of Korean Speakers * | 0.03 | 0.09 | 0.00 | 0.00–0.77 |
% of Russian Speakers * | 0.01 | 0.03 | 0.00 | 0.00–0.37 |
Housing Type/Transportation | ||||
% of Housing Structures with 10 or More Units | 3.50 | 4.61 | 1.90 | 0.00–28.10 |
% of Mobile Homes | 15.46 | 7.92 | 14.45 | 1.50–51.40 |
% of Housing Units with More People than Rooms | 4.27 | 2.69 | 3.65 | 0.00–21.20 |
% of Households with No Vehicle Available | 5.05 | 2.21 | 5.05 | 0.00–14.40 |
% of Persons in Living in Institutionalized Group Quarters | 4.25 | 6.17 | 1.60 | 0.00–36.50 |
Healthcare Infrastructure and Access | ||||
Hospitals per 100,000 Persons | 6.68 | 10.7 | 3.49 | 0.00–82.55 |
Urgent Care Clinics per 100,000 Persons | 0.61 | 2.27 | 0.00 | 0.00–27.52 |
Pharmacies per 100,000 Persons | 18.55 | 11.83 | 17.53 | 0.00–72.20 |
Primary Care Physicians per 100,000 Persons | 0.38 | 0.28 | 0.33 | 0.00–1.39 |
% of Persons Without Health Insurance | 17.38 | 4.60 | 17.10 | 4.70–33.40 |
Medical Vulnerability | ||||
Total Cardiovascular Disease Death Rate per 100,000 | 496.56 | 97.89 | 485.80 | 314.70–834.80 |
Chronic Respiratory Diseases Rate per 100,000 | 63.86 | 17.56 | 63.64 | 26.91–113.39 |
Total Persons with Obesity ** | 31,087.01 | 5547.05 | 30,300.00 | 20,500.00–47,700.00 |
Total Persons Diagnosed with Diabetes ** | 10,042.91 | 4318.40 | 9400.00 | 2300.00–26,800.00 |
% of persons with No Internet access | 25.13 | 8.37 | 24.95 | 6.54–55.02 |
Covariates | ||||
Population Density | 44.81 | 132.39 | 8.36 | 0.06–1145.19 |
Political Affiliations | ||||
Trump Voters n =232, 91.34% | - | - | - | - |
Biden Voters n = 22, 8.66% | - | - | - | - |
% Female | 49.06 | 3.10 | 50.15 | 29.37–53.27 |
Urbanicity | ||||
Suburban n = 82, 32.28% | - | - | - | - |
Suburban n = 84, 33.07% | - | - | - | - |
Rural n = 88, 34.65% | - | - | - | - |
% of Adult Smokers in the County | 14.94 | 1.56 | 14.89 | 10.64–19.87 |
% of Residents Received At Least One Dose of the COVID-19 Vaccine | 53.16 | 14.07 | 50.85 | 0.62–78.00 |
County Mean Life Expectancy | 77.46 | 2.33 | 77.45 | 71.86–89.65 |
Average Particulate Matter (PM)2.5 | 8.68 | 1.34 | 8.75 | 5.60–12.00 |
County Median Age | 39.56 | 5.74 | 39.15 | 27.90–60.00 |
Unadjusted COVID-19 Mortality Rate a,c | Adjusted COVID-19 Mortality Rate b,c | |||||
---|---|---|---|---|---|---|
IRR | 95% CI | p-Value | IRR | 95% CI | p-Value | |
Covariates d (n = 254) | ||||||
Population Density | 0.99 | 0.99–1.00 | <0.001 | 0.99 | 0.99–1.00 | 0.001 |
Political Affiliations | ||||||
Trump Voters | REF | REF | ||||
Biden Voters | 0.89 | 0.76–1.04 | 0.136 | 1.27 | 1.10–1.45 | 0.001 |
% Female | 1.01 | 0.99–1.02 | 0.763 | 1.02 | 1.01–1.03 | 0.005 |
Urbanicity | ||||||
Urban | REF | REF | ||||
Suburban | 1.35 | 1.22–1.48 | <0.001 | 1.12 | 1.03–1.21 | 0.005 |
Rural | 1.36 | 1.23–1.51 | <0.001 | 1.03 | 0.94–1.14 | 0.483 |
Percentage of Adult Smokers in the County | 1.07 | 1.04–1.10 | <0.001 | 1.04 | 1.01–1.06 | 0.005 |
Vaccination Coverage (receiving at least one dose of the COVID-19 vaccine) | 0.99 | 0.98–0.99 | <0.001 | 0.99 | 0.99–1.00 | 0.013 |
County Mean Life Expectancy | 0.94 | 0.92–0.95 | <0.001 | 0.95 | 0.93–0.96 | <0.001 |
Average Particulate Matter (PM)2.5 | 0.89 | 0.86–0.92 | <0.001 | 0.89 | 0.86–0.92 | <0.001 |
County Median Age | 1.01 | 1.00–1.02 | 0.028 | 1.01 | 1.00–1.01 | 0.018 |
Variable d | Unadjusted COVID-19 Mortality Rate a,c | Adjusted COVID-19 Mortality Rate b,c | ||||
---|---|---|---|---|---|---|
IRR | 95% CI | p-Value | IRR | 95% CI | p-Value | |
Composite/Overall MH SVI | 1.10 | 0.91–1.33 | 0.328 | 1.27 | 1.04–1.55 | 0.017 |
Socioeconomic Status | 1.95 | 1.62–2.35 | <0.001 | 1.55 | 1.28–1.89 | 0.001 |
Household Composition/ Disability | 1.86 | 1.62–2.15 | <0.001 | 1.47 | 1.29–1.68 | <0.001 |
Minority Status/Language | 0.52 | 0.42–0.63 | <0.001 | 0.94 | 0.76–1.16 | 0.572 |
Housing Type/Transportation | 0.95 | 0.81–1.12 | 0.554 | 1.06 | 0.91–1.23 | 0.425 |
Healthcare Infrastructure and Access | 1.23 | 1.01–1.51 | 0.038 | 0.97 | 0.83–1.11 | 0.654 |
Medical Vulnerabilities | 1.72 | 1.44–2.06 | <0.001 | 1.14 | 0.95–1.38 | 0.157 |
Variable d | Unadjusted COVID-19 Mortality Rate a,c | Adjusted COVID-19 Mortality Rate b,c | ||||
---|---|---|---|---|---|---|
IRR | 95% CI | p-Value | IRR | 95% CI | p-Value | |
Socioeconomic Status | ||||||
% of Persons Living Below Poverty | 1.02 | 1.00–1.03 | <0.001 | 1.01 | 1.00–1.02 | 0.006 |
% of Civilians Aged 16+ Unemployed | 1.02 | 1.00–1.04 | 0.013 | 1.01 | 1.00–1.03 | 0.093 |
Income Per Capita | 0.99 | 0.99–1.00 | <0.001 | 0.99 | 0.99–1.00 | <0.001 |
% of Persons Aged 25+ with No High School Diploma | 1.01 | 1.01–1.02 | <0.001 | 1.01 | 1.00–1.02 | <0.001 |
Household Composition/ Disability | ||||||
% of Persons Aged 65 and Older | 1.02 | 1.01–1.03 | <0.001 | 1.04 | 1.03–1.05 | <0.001 |
% of Persons Aged 17 and Younger | 1.01 | 0.99–1.01 | 0.940 | 1.01 | 0.99–1.02 | 0.459 |
% of Civilian Noninstitutionalized Population with a Disability | 1.03 | 1.03–1.05 | <0.001 | 1.01 | 1.00–1.02 | 0.008 |
% of Single Parent Household with Children Under 18 | 1.01 | 1.00–1.03 | 0.064 | 1.02 | 1.01–1.03 | 0.005 |
Minority Status/Language | ||||||
% of American Indian/Alaska Native | 1.06 | 0.97–1.15 | 0.206 | 0.98 | 0.92–1.04 | 0.592 |
% of Asian | 0.92 | 0.90–0.93 | <0.001 | 0.97 | 0.95–0.98 | <0.001 |
% of African American | 0.99 | 0.98–1.00 | 0.003 | 0.99 | 0.98–1.01 | 0.096 |
% of Native Hawaiian/Pacific Islander | 0.90 | 0.66–1.21 | 0.489 | 0.97 | 0.78–1.20 | 0.816 |
% of Hispanic or Latinx | 1.01 | 0.99–1.00 | 0.138 | 1.01 | 1.00–1.01 | <0.001 |
% of Some Other Race | 0.99 | 0.99–1.00 | 0.585 | 0.99 | 0.99–1.00 | 0.601 |
% of Spanish Speakers * | 1.01 | 1.00–1.01 | 0.554 | 1.01 | 1.00–1.01 | 0.046 |
% of Chinese Speakers * | 0.56 | 0.47–0.69 | <0.001 | 0.76 | 0.65–0.89 | 0.001 |
% of Vietnamese Speakers * | 0.58 | 0.46–0.72 | <0.001 | 0.87 | 0.73–1.03 | 0.114 |
% of Korean Speakers * | 0.42 | 0.27–0.66 | <0.001 | 0.79 | 0.55–1.12 | 0.185 |
% of Russian Speakers * | 0.05 | 0.01–0.18 | <0.001 | 0.19 | 0.07–0.51 | 0.001 |
Housing Type/Transportation | ||||||
% of Housing Structures with 10 or More Units | 0.96 | 0.95–0.97 | <0.001 | 0.98 | 0.97–0.98 | <0.001 |
% of Mobile Homes | 1.01 | 0.99–1.01 | 0.802 | 0.99 | 1.00–1.00 | 0.509 |
% of Housing Units with More People than Rooms | 1.01 | 0.98–1.02 | 0.747 | 1.01 | 0.99–1.03 | 0.120 |
% of Households with No Vehicle Available | 1.04 | 1.02–1.06 | <0.001 | 1.03 | 1.01–1.05 | 0.002 |
% of Persons in Living in Institutionalized Group Quarters | 0.99 | 0.99–1.00 | 0.479 | 0.99 | 0.99–1.01 | 0.428 |
Healthcare Infrastructure and Access | ||||||
Hospitals per 100,000 Persons | 1.01 | 1.00–1.01 | 0.014 | 0.99 | 0.99–1.00 | 0.571 |
Urgent Care Clinics per 100,000 Persons | 0.99 | 0.98–1.01 | 0.590 | 1.01 | 0.99–1.02 | 0.582 |
Pharmacies per 100,000 Persons | 1.01 | 1.00–1.01 | 0.015 | 1.01 | 1.00–1.01 | 0.224 |
Primary Care Physicians per 100,000 Persons | 0.80 | 0.68–0.94 | 0.006 | 1.01 | 0.88–1.13 | 0.978 |
% of Persons Without Health Insurance | 1.02 | 1.01–1.03 | <0.001 | 1.01 | 1.00–1.02 | 0.033 |
Medical Vulnerability | ||||||
Total Cardiovascular Disease Death Rate per 100,000 | 1.01 | 1.00–1.01 | <0.001 | 1.00 | 0.99–1.01 | 0.970 |
Chronic Respiratory Diseases Rate per 100,000 | 1.01 | 1.00–1.01 | <0.001 | 0.99 | 0.99–1.00 | 0.027 |
Total Persons with Obesity ** | 1.01 | 0.99–1.01 | 0.725 | 1.00 | 0.99–1.00 | 0.947 |
Total Persons Diagnosed with Diabetes ** | 1.01 | 0.99–1.00 | 0.620 | 1.00 | 0.99–1.01 | 0.653 |
% of Persons with No Internet Access | 1.02 | 1.02–1.03 | <0.001 | 1.01 | 1.01–1.02 | <0.001 |
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Nyachoti, D.O.; Ranjit, N.; Ramphul, R.; Whigham, L.D.; Springer, A.E. Association of Social Vulnerability and COVID-19 Mortality Rates in Texas between 15 March 2020, and 21 July 2022: An Ecological Analysis. Int. J. Environ. Res. Public Health 2023, 20, 6985. https://doi.org/10.3390/ijerph20216985
Nyachoti DO, Ranjit N, Ramphul R, Whigham LD, Springer AE. Association of Social Vulnerability and COVID-19 Mortality Rates in Texas between 15 March 2020, and 21 July 2022: An Ecological Analysis. International Journal of Environmental Research and Public Health. 2023; 20(21):6985. https://doi.org/10.3390/ijerph20216985
Chicago/Turabian StyleNyachoti, Dennis Ogeto, Nalini Ranjit, Ryan Ramphul, Leah D. Whigham, and Andrew E. Springer. 2023. "Association of Social Vulnerability and COVID-19 Mortality Rates in Texas between 15 March 2020, and 21 July 2022: An Ecological Analysis" International Journal of Environmental Research and Public Health 20, no. 21: 6985. https://doi.org/10.3390/ijerph20216985