Associations Between Primary Care Provider Shortage Areas and County-Level COVID-19 Infection and Mortality Rates in the USA

Ku, Benson S.; Druss, Benjamin G.

doi:10.1007/s11606-020-06130-4

Cited by 14 publications

(12 citation statements)

References 2 publications

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“…For the adjusted analyses, we selected variables unrelated to the components of SVI that could explain the differential impact of COVID-19 on upper and lower SVI counties. These variables were chosen a priori based on previously reported associations with COVID-19 incidence and deaths [17–19, 28–31]. We obtained several health and environmental factors from the Robert Wood Johnson Foundation’s 2019 County Health Rankings & Roadmaps: Rankings Data & Documentation [32].…”

Section: Methodsmentioning

confidence: 99%

“…For the adjusted analyses, we selected variables unrelated to the components of SVI that could explain the differential impact of COVID-19 on upper and lower SVI counties. These variables were chosen a priori based on previously reported associations with COVID-19 incidence and deaths [17][18][19][28][29][30][31]. (county-level data are not currently available).…”

Section: Adjustment Variablesmentioning

confidence: 99%

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Spatial and temporal trends in social vulnerability and COVID-19 incidence and death rates in the United States

Neelon

Mutiso

Mueller

et al. 2020

Preprint

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Background: Emerging evidence suggests that socially vulnerable communities are at higher risk for coronavirus disease 2019 (COVID-19) outbreaks in the United States. However, no prior studies have examined temporal trends and differential effects of social vulnerability on COVID-19 incidence and death rates. The purpose of this study was to examine temporal trends among counties with high and low social vulnerability and to quantify disparities in these trends over time. We hypothesized that highly vulnerable counties would have higher incidence and death rates compared to less vulnerable counties and that this disparity would widen as the pandemic progressed. Methods: We conducted a retrospective longitudinal analysis examining COVID-19 incidence and death rates from March 1 to August 31, 2020 for each county in the US. We obtained daily COVID-19 incident case and death data from USAFacts and the Johns Hopkins Center for Systems Science and Engineering. We classified counties using the Social Vulnerability Index (SVI), a percentile-based measure from the Centers for Disease Control and Prevention in which higher scores represent more vulnerability. Using a Bayesian hierarchical negative binomial model, we estimated daily risk ratios (RRs) comparing counties in the first (lower) and fourth (upper) SVI quartiles. We adjusted for percentage of the county designated as rural, percentage in poor or fair health, percentage of adult smokers, county average daily fine particulate matter (PM2.5), percentage of primary care physicians per 100,000 residents, and the proportion tested for COVID-19 in the state. Results: In unadjusted analyses, we found that for most of March 2020, counties in the upper SVI quartile had significantly fewer cases per 100,000 than lower SVI quartile counties. However, on March 30, we observed a crossover effect in which the RR became significantly greater than 1.00 (RR = 1.10, 95% PI: 1.03, 1.18), indicating that the most vulnerable counties had, on average, higher COVID-19 incidence rates compared to least vulnerable counties. Upper SVI quartile counties had higher death rates on average starting on March 30 (RR = 1.17, 95% PI: 1.01,1.36). The death rate RR achieved a maximum value on July 29 (RR = 3.22, 95% PI: 2.91, 3.58), indicating that most vulnerable counties had, on average, 3.22 times more deaths per million than the least vulnerable counties. However, by late August, the lower quartile started to catch up to the upper quartile. In adjusted models, the RRs were attenuated for both incidence cases and deaths, indicating that the adjustment variables partially explained the associations. We also found positive associations between COVID-19 cases and deaths and percentage of the county designated as rural, percentage of resident in fair or poor health, and average daily PM2.5. Conclusions: Results indicate that the impact of COVID-19 is not static but can migrate from less vulnerable counties to more vulnerable counties over time. This highlights the importance of protecting vulnerable populations as the pandemic unfolds.

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Section: Methodsmentioning

confidence: 99%

“…For the adjusted analyses, we selected variables unrelated to the components of SVI that could explain the differential impact of COVID-19 on upper and lower SVI counties. These variables were chosen a priori based on previously reported associations with COVID-19 incidence and deaths [17][18][19][28][29][30][31]. (county-level data are not currently available).…”

Section: Adjustment Variablesmentioning

confidence: 99%

Spatial and temporal trends in social vulnerability and COVID-19 incidence and death rates in the United States

Neelon

Mutiso

Mueller

et al. 2020

Preprint

View full text Add to dashboard Cite

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“…We adjusted for several variables that could help explain the differential impact of COVID-19 on upper and lower SVI counties. These variables were chosen a priori based on previously reported associations with COVID-19 incidence and deaths [20][21][22][35][36][37][38]. As noted above, we provide data sources for all variables in Table 1.…”

Section: Adjustment Variablesmentioning

confidence: 99%

Spatial and temporal trends in social vulnerability and COVID-19 incidence and death rates in the United States

et al. 2021

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Background Socially vulnerable communities may be at higher risk for COVID-19 outbreaks in the US. However, no prior studies examined temporal trends and differential effects of social vulnerability on COVID-19 incidence and death rates. Therefore, we examined temporal trends among counties with high and low social vulnerability to quantify disparities in trends over time. Methods We conducted a longitudinal analysis examining COVID-19 incidence and death rates from March 15 to December 31, 2020, for each US county using data from USAFacts. We classified counties using the Social Vulnerability Index (SVI), a percentile-based measure from the Centers for Disease Control and Prevention, with higher values indicating more vulnerability. Using a Bayesian hierarchical negative binomial model, we estimated daily risk ratios (RRs) comparing counties in the first (lower) and fourth (upper) SVI quartiles, adjusting for rurality, percentage in poor or fair health, percentage female, percentage of smokers, county average daily fine particulate matter (PM2.5), percentage of primary care physicians per 100,000 residents, daily temperature and precipitation, and proportion tested for COVID-19. Results At the outset of the pandemic, the most vulnerable counties had, on average, fewer cases per 100,000 than least vulnerable SVI quartile. However, on March 28, we observed a crossover effect in which the most vulnerable counties experienced higher COVID-19 incidence rates compared to the least vulnerable counties (RR = 1.05, 95% PI: 0.98, 1.12). Vulnerable counties had higher death rates starting on May 21 (RR = 1.08, 95% PI: 1.00,1.16). However, by October, this trend reversed and the most vulnerable counties had lower death rates compared to least vulnerable counties. Conclusions The impact of COVID-19 is not static but can migrate from less vulnerable counties to more vulnerable counties and back again over time.

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“…14 This paper examines vaccine hesitancy among adults living, working, or receiving care in Arkansas. Arkansas is in the top 10 states for rural populations (43.84%), which often lack adequate health care resources and primary care providers, 15 and is ranked third among US states with the highest percentages (46.50%) of populations at high risk for serious illness due to COVID-19. 16 The following research questions were examined: (1) What proportion of Arkansans are hesitant to receive a vaccine for COVID-19?…”

Section: Introductionmentioning

confidence: 99%

COVID‐19 vaccine hesitancy: Race/ethnicity, trust, and fear

Willis

Andersen

Bryant-Moore

et al. 2021

Clinical Translational Sci

306

206

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Associations Between Primary Care Provider Shortage Areas and County-Level COVID-19 Infection and Mortality Rates in the USA

Cited by 14 publications

References 2 publications

Spatial and temporal trends in social vulnerability and COVID-19 incidence and death rates in the United States

Spatial and temporal trends in social vulnerability and COVID-19 incidence and death rates in the United States

Spatial and temporal trends in social vulnerability and COVID-19 incidence and death rates in the United States

COVID‐19 vaccine hesitancy: Race/ethnicity, trust, and fear

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