COVID-19 and the Social Determinants of Health

Rollston, Rebekah; Galea, Sandro

doi:10.1177/0890117120930536b

Cited by 126 publications

(112 citation statements)

References 6 publications

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“…Even in rich countries, such as the United States of America (USA), the social inequalities that exist in cities determine the greater or lesser risk of illness for their residents. In Boston, for example, there is a high concentration of poverty and a prevalence of diseases caused by it in certain areas and good living conditions and a low prevalence of these diseases in other nearby points [19,20]. This scenario reinforces the relationship between social policies and the health conditions experienced by the population.…”

Section: Discussionmentioning

confidence: 99%

Human development, social vulnerability and COVID-19 in Brazil: a study of the social determinants of health

2020

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Background: Coronavirus disease 2019 (COVID-19) was confirmed in Brazil in February 2020. Since then, the disease has spread throughout the country, reaching the poorest areas. This study analyzes the relationship between COVID-19 and the population's living conditions. We aimed to identify social determinants related to the incidence, mortality, and case fatality rate of COVID-19 in Brazil, in 2020. Methods: This is an ecological study evaluating the relationship between COVID-19 incidence, mortality, and case fatality rates and 49 social indicators of human development and social vulnerability. For the analysis, bivariate spatial correlation and multivariate and spatial regression models (spatial lag model and spatial error models) were used, considering a 95% confidence interval and a significance level of 5%. Results: A total of 44.8% of municipalities registered confirmed cases of COVID-19 and 14.7% had deaths. We observed that 56.2% of municipalities with confirmed cases had very low human development (COVID-19 incidence rate: 59.00/100 000; mortality rate: 36.75/1 000 000), and 52.8% had very high vulnerability (COVID-19 incidence rate: 41.68/100 000; mortality rate: 27.46/1 000 000). The regression model showed 17 indicators associated with transmission of COVID-19 in Brazil. Conclusions: Although COVID-19 first arrived in the most developed and least vulnerable municipalities in Brazil, it has already reached locations that are farther from large urban centers, whose populations are exposed to a context of intense social vulnerability. Based on these findings, it is necessary to adopt measures that take local social aspects into account in order to contain the pandemic.

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Section: Discussionmentioning

confidence: 99%

Human development, social vulnerability and COVID-19 in Brazil: a study of the social determinants of health

2020

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“…Some states have substantially higher magnitudes of racial/ethnic disparities than others, and even the direction of the disparity within a racial/ethnic group can differ state to state. This substantial state-to-state variation consequently suggests that racial/ethnic disparities in the COVID-19 mortality burden are driven in large part by social determinants of health [81] whose degree of association with race/ethnicity varies by state, a perspective widely propounded in the scientific community [82][83][84][85][86][87].…”

Section: Discussionmentioning

confidence: 99%

Racial and Ethnic Disparities in Years of Potential Life Lost Attributable to COVID-19 in the United States: An Analysis of 45 States and the District of Columbia

Chen

Belin

et al. 2021

IJERPH

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The coronavirus disease 2019 (COVID-19) epidemic in the United States has disproportionately impacted communities of color across the country. Focusing on COVID-19-attributable mortality, we expand upon a national comparative analysis of years of potential life lost (YPLL) attributable to COVID-19 by race/ethnicity (Bassett et al., 2020), estimating percentages of total YPLL for non-Hispanic Whites, non-Hispanic Blacks, Hispanics, non-Hispanic Asians, and non-Hispanic American Indian or Alaska Natives, contrasting them with their respective percent population shares, as well as age-adjusted YPLL rate ratios—anchoring comparisons to non-Hispanic Whites—in each of 45 states and the District of Columbia using data from the National Center for Health Statistics as of 30 December 2020. Using a novel Monte Carlo simulation procedure to perform estimation, our results reveal substantial racial/ethnic disparities in COVID-19-attributable YPLL across states, with a prevailing pattern of non-Hispanic Blacks and Hispanics experiencing disproportionately high and non-Hispanic Whites experiencing disproportionately low COVID-19-attributable YPLL. Furthermore, estimated disparities are generally more pronounced when measuring mortality in terms of YPLL compared to death counts, reflecting the greater intensity of the disparities at younger ages. We also find substantial state-to-state variability in the magnitudes of the estimated racial/ethnic disparities, suggesting that they are driven in large part by social determinants of health whose degree of association with race/ethnicity varies by state.

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“…For COVID-19, this racial gap in socioeconomic outcomes could translate into racially patterned differences in access to health-preserving resources, such as healthcare, sanitizers and masks, and adequate shelter, as well as racially differentiated occupational and place-based risks [ 40 , 41 ].…”

Section: Introductionmentioning

confidence: 99%

Structural Racism and COVID-19 in the USA: a County-Level Empirical Analysis

Tan

deSouza

Raifman

2021

J. Racial and Ethnic Health Disparities

134

107

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Substantial health disparities exist across race/ethnicity in the USA, with Black Americans often most affected. The current COVID-19 pandemic is no different. While there have been ample studies describing racial disparities in COVID-19 outcomes, relatively few have established an empirical link between these disparities and structural racism. Such empirical analyses are critically important to help defuse "victim-blaming" narratives about why minority communities have been badly hit by COVID-19. In this paper, we explore the empirical link between structural racism and disparities in county-level COVID-19 outcomes by county racial composition. Using negative binomial regression models, we examine how five measures of county-level residential segregation and racial disparities in socioeconomic outcomes as well as incarceration rates are associated with county-level COVID-19 outcomes. We find significant associations between higher levels of measured structural racism and higher rates of COVID-19 cases and deaths, even after adjusting for county-level population sociodemographic characteristics, measures of population health, access to healthcare, population density, and duration of the COVID-19 outbreak. One percentage point more Black residents predicted a 1.1% increase in county case rate. This association decreased to 0.4% when structural racism indicators were included in our model. Similarly, one percentage point more Black residents predicted a 1.8% increase in county death rates, which became non-significant after adjustment for structural racism. Our findings lend empirical support to the hypothesis that structural racism is an important driver of racial disparities in COVID-19 outcomes, and reinforce existing calls for action to address structural racism as a fundamental cause of health disparities.

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COVID-19 and the Social Determinants of Health

Abstract: L ifestyle (as) medicine has been increasingly recognized as a powerful therapy for prevention, control, and even reversal/remission of now well-established risk factors for COVID-19-associated

Cited by 126 publications

References 6 publications

Human development, social vulnerability and COVID-19 in Brazil: a study of the social determinants of health

Human development, social vulnerability and COVID-19 in Brazil: a study of the social determinants of health

Racial and Ethnic Disparities in Years of Potential Life Lost Attributable to COVID-19 in the United States: An Analysis of 45 States and the District of Columbia

Structural Racism and COVID-19 in the USA: a County-Level Empirical Analysis

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