Socioeconomic disadvantage is associated with increased risk of mortality from COVID-19
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Background and Aim: Living in a disadvantaged neighborhood has been linked to many adverse health outcomes. Chronic social and economic stressors associated with disadvantaged neighborhoods may also contribute to an increased risk of severe outcomes following infection with SARS-CoV-2, the causative agent of COVID-19. The aim of this study was to compare a standardized metric of neighborhood socioeconomic deprivation with COVID-19 mortality rates and case fatality rates. Methods: The area deprivation index (ADI) is a standardized measure of community deprivation based on 21 census-block level socioeconomic indicators (https://www.neighborhoodatlas.medicine.wisc.edu/). ADI is scaled from 1-100, with 1 indicating the least deprivation and 100 the most deprivation. For analysis, ADI was aggregated to county using the R-package “sociome”, and categorized into quintiles and deciles. County level COVID-19 cases and mortality were obtained from the COVID-19 Data Repository maintained by Johns Hopkins University. Mortality and case-fatality rates were modeled as a function of ADI using a mixed effects negative binomial model, with a random intercept for state, controlling for percentage over age 65, percentage male, and percentage non-white. Results: Mortality rates ranged across quintiles of increasing ADI from 123, 163, 159, 176, to 233 deaths per 100,000 total population. Adjusted incidence rate ratios relative to the least deprivation were: 1.20 (95% CI: 1.15-1.27); 1.34 (95% CI 1.28-1.42); 1.54 (95% CI 1.46-1.63); 1.89 (95% CI 1.78-2.01) for the second through fifth quantiles of deprivation, respectively. Deciles of ADI showed a similar consistent trend (p<0.0001) with increasing mortality. Counties in the upper 10th decile of deprivation experienced an excess of 124 deaths per 100,000 population due to COVID-19 compared to the least deprived (95% CI: 98.7-150.1). Case fatality rates also increased consistently with increasing ADI. Conclusions: Socioeconomically disadvantaged counties experienced higher mortality and case fatality rates due to COVID-19.