ABSTRACT
RATIONALE: Chronic respiratory diseases, the third leading cause of death worldwide, have been associated with significant morbidity, mortality, and increased economic burden, which make a profound impact on individuals and communities. However, limited research has delineated complex relationships between specific sociodemographic disparities and chronic respiratory disease outcomes among US counties. OBJECTIVE: To assess the association of county-level sociodemographic vulnerabilities with chronic respiratory diseases mortality in the US. METHODS: Chronic respiratory diseases mortality data among US counties for 2014-2018 was obtained from the Centers for Disease Control and Prevention, Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) database. Social Vulnerability Index (SVI), including subindices of Socioeconomic Status, Household Composition & Disability, Minority Status & Language, and Housing Type & Transportation, is a composite, percentile-based measure developed by the CDC to evaluate county-level sociodemographic vulnerabilities to disasters. We examined county-level sociodemographic characteristics from the SVI and classified the percentile rank into quartiles, with higher quartile indicating greater vulnerability. The associations between chronic respiratory diseases mortality and overall SVI, its four subindices, and each county characteristic were analyzed by negative binomial regression. RESULTS: From 2014 to 2018, the age-adjusted mortality per 1,000,000 population attributed to chronic lower respiratory disease (CLRD) was 406.4 (95% CI: 405.5-407.3); chronic obstructive pulmonary disease (COPD), 393.7 (392.8-394.6); Asthma, 10.0 (9.9-10.2); interstitial lung disease (ILD), 50.5 (50.1-50.8); idiopathic pulmonary fibrosis (IPF), 37.0 (36.7-37.3); and Sarcoidosis, 5.3 (5.2-5.4). Counties in the higher quartile of overall SVI were significantly associated with greater diseases mortality (CLRD, incidence rate ratios: 4th versus 1st quartile, 1.43 [95% CI: 1.39-1.48]; COPD, 1.44 [1.39-1.49]; Asthma, 2.06 [1.71-2.48]; ILD, 1.07 [1.02-1.13]; IPF, 1.14 [1.06-1.22]; Sarcoidosis, 2.01 [1.44-2.81]). Additionally, higher mortality was also found in counties in the higher quartile of each subindex and most sociodemographic characteristics. CONCLUSIONS: Chronic respiratory diseases mortalities were significantly associated with county-level sociodemographic determinants as measured by the SVI in the US. These findings suggested sociodemographic determinants may add a considerable barrier to establishing health equity. Multilevel public health strategies and clinical interventions addressing inequitable outcomes of chronic respiratory diseases should be developed and targeted on areas with greater social vulnerability and disadvantage.
ABSTRACT
Background: The disproportionate burden of COVID-19 pandemic has become a major concern in the United States (US), but the association between COVID-19 case-fatality rate (CFR) and factors influencing health outcomes at a state level has not been evaluated. Methods: We calculated COVID-19 CFR for three different waves using COVID Data Tracker from the Centers for Disease Control and Prevention. America's Health Rankings assesses the factors that influence health outcomes to determine state's health rankings. The association between COVID-19 CFR and state health disparities was analyzed by linear regression. Results: States with better rankings of Physical Environment were associated with lower CFR for the 1st wave (ß = 0.06%, R2 = 0.170, P = 0.003). There was a paradoxical association between the 2nd wave CFR and Clinical Care (ß = -0.04%, R2 = 0.112, P = 0.017) and Overall health rankings (ß = -0.03%, R2 = 0.096, P = 0.029). For the 3rd wave, states with better rankings of Overall health factors (ß = 0.01%, R2 = 0.179, P = 0.002), Social & Economic Factors (ß = 0.01%, R2 = 0.176, P = 0.002), Behaviors (ß = 0.01%, R2 = 0.204, P < 0.001), and Health Outcomes (ß = 0.01%, R2 = 0.163, P = 0.004) were associated with lower CFR. COVID-19 vaccination coverage was also associated with state health rankings (at least one dose: ß = -0.13%, R2 = 0.305, P < 0.001; fully vaccinated: ß = -0.06%, R2 = 0.120, P = 0.014). Conclusions: These findings suggested targeted public health interventions and mitigation strategies addressing health disparities are essential to improve inequitable outcomes of COVID-19 in the US.