Measuring geographical disparities in England at the time of COVID-19: results using a composite indicator of population vulnerability

Abstract

ObjectivesThe growth of COVID-19 infections in England raises questions about system vulnerability. Several factors that vary across geographies, such as age, existing disease prevalence, medical resource availability and deprivation, can trigger adverse effects on the National Health System during a pandemic. In this paper, we present data on these factors and combine them to create an index to show which areas are more exposed. This technique can help policy makers to moderate the impact of similar pandemics.DesignWe combine several sources of data, which describe specific risk factors linked with the outbreak of a respiratory pathogen, that could leave local areas vulnerable to the harmful consequences of large-scale outbreaks of contagious diseases. We combine these measures to generate an index of community-level vulnerability.Setting91 Clinical Commissioning Groups (CCGs) in England.Main outcome measuresWe merge 15 measures spatially to generate an index of community-level vulnerability. These measures cover prevalence rates of high-risk diseases; proxies for the at-risk population density; availability of staff and quality of healthcare facilities.ResultsWe find that 80% of CCGs that score in the highest quartile of vulnerability are located in the North of England (24 out of 30). Here, vulnerability stems from a faster rate of population ageing and from the widespread presence of underlying at-risk diseases. These same areas, especially the North-East Coast areas of Lancashire, also appear vulnerable to adverse shocks to healthcare supply due to tighter labour markets for healthcare personnel. Importantly, our index correlates with a measure of social deprivation, indicating that these communities suffer from long-standing lack of economic opportunities and are characterised by low public and private resource endowments.ConclusionsEvidence-based policy is crucial to mitigate the health impact of pandemics such as COVID-19. While current attention focuses on curbing rates of contagion, we introduce a vulnerability index combining data that can help policy makers identify the most vulnerable communities. We find that this index is positively correlated with COVID-19 deaths and it can thus be used to guide targeted capacity building. These results suggest that a stronger focus on deprived and vulnerable communities is needed to tackle future threats from emerging and re-emerging infectious disease.

Variability in COVID-19 in-hospital mortality rates between national health service trusts and regions in England: A national observational study for the Getting It Right First Time Programme

“…Early in the pandemic, when awareness of the disease was low and community transmission rates were high, patients are likely to have been more severely ill at presentation. Geographical factors including at risk population density surrounding a hospital [27] , and proximity of neighbouring acute hospitals will also have influenced COVID-19 patient flow and potential for patient surges.…”

Population Mobility Trends, Deprivation Index and the Spatio-Temporal Spread of Coronavirus Disease 2019 in Ireland

“…Another potentially important spatial consideration for COVID-19 is that socioeconomically deprived areas often display a higher prevalence of pre-existing health conditions and lower access to health care services. In terms of COVID-19, this may accentuate problems for deprived communities as they may be disproportionately vulnerable to infectious diseases [ 9 ]. For a national health system, and policy decision making during a pandemic, it is critically important to be aware of such disparities, if they exist.…”

HIV Infection Prevalence Significantly Intersects With COVID-19 Infection At the Area Level: A US County-Level Analysis

“… 11 – 14 Rather, higher burden of disease and disparities across COVID-19 and HIV infection are shaped by the inequitable distribution of socioeconomic resources 15 – 18 and other vulnerability-related determinants 19 , 20 such as environmental health hazards, violence, poorer access to care, and other trauma-causing exposures. 6 , 21 , 22 …”