ArticleBMJ open2021
Temporal trends in the association of social vulnerability and race/ethnicity with county-level COVID-19 incidence and outcomes in the USA: an ecological analysis.
Article in BMJ open, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 40 papers, 1 of them a synthesis that pooled it.
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Who cites it
40 citing papers in PubMed, 1 synthesis or guideline pooled it, 71 citations in OpenAlex.
- Disparities in COVID-19 related outcomes in the United States by race and ethnicity pre-vaccination era: an umbrella review of meta-analyses.Frontiers in public health · 2023Pooled it
- Engaging Black and Latinx Communities in Building Capacity for Behavioral Health.Behavioral sciences (Basel, Switzerland) · 2026Article
- Social vulnerability and spatial patterns of COVID-19 mortality: Global implications for respiratory health equity.PloS one · 2026Article
- Article
- Association Between Social Vulnerability and Infection-Induced SARS-CoV-2 Antibody Seroprevalence Among Children: United States, 2021-2022.Public health reports (Washington, D.C. : 1974) · 2025Article
- The association between food benefit online ordering and redemptions: evidence from the Special Supplemental Nutrition Program for Women, Infants, and Children.Public health nutrition · 2025Article
- Cardiac Arrest Mortality Across Time and Space: A National Analysis with Forecasts to 2035.Journal of clinical medicine · 2025Article
- Minority health social vulnerability index and long COVID illness among a statewide, population-based study of adults with polymerase chain reaction-confirmed SARS-CoV-2.Archives of public health = Archives belges de sante publique · 2025Article
- Perception of Risk for Developing Severe Illness or Complications from COVID-19 in Brazil: Focus on Factors Linked to Socially Vulnerable Populations, 2020-2023.International journal of environmental research and public health · 2025Article
- Associations of County-Level Social Determinants of Health with COVID-19 Related Hospitalization Among People with HIV: A Retrospective Analysis of the U.S. National COVID Cohort Collaborative (N3C).AIDS and behavior · 2024Article
- Social Vulnerability Index and All-Cause Mortality After Acute Ischemic Stroke, Medicare Cohort 2020-2023.JACC. Advances · 2024Article
- Disparities in the real-world prescription pattern of oral anticoagulants for US Medicare beneficiaries: a geospatial analysis.BMJ open · 2024Article
- Social-Economic Backgrounds to US County-Based COVID-19 Deaths: PLS-SEM Analysis.Journal of racial and ethnic health disparities · 2024Article
- Social Vulnerability May Underlie Racial Disparities in Peripartum Cardiomyopathy Outcomes.Ethnicity & disease · 2024Article
- An Application of Social Vulnerability Index to Infant Mortality Rates in Ohio Using Geospatial Analysis- A Cross-Sectional Study.Maternal and child health journal · 2024Article
- Association of social vulnerability index and masking adherence among children enrolled in COVID-19 community research partnership study.BMC public health · 2024Article
- Inequality in COVID-19 mortality in Quebec associated with neighbourhood-level vulnerability domains.Canadian journal of public health = Revue canadienne de sante publique · 2024Article
- Differential associations of mask mandates on COVID-19 infection and mortality by community social vulnerability.American journal of infection control · 2024Article
- Incidence of Stomach, Liver, and Colorectal Cancers by Geography and Social Vulnerability Among American Indian and Alaska Native Populations, 2010-2019.American journal of epidemiology · 2024Article
- Evolving patterns of COVID-19 mortality in US counties: A longitudinal study of healthcare, socioeconomic, and vaccination associations.PLOS global public health · 2024Article
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14 authors at 1 institution in 1 country.
Funding
Abstract
backgroundThe COVID-19 pandemic adversely affected the socially vulnerable and minority communities in the USA initially, but the temporal trends during the year-long pandemic remain unknown.
objectiveWe examined the temporal association of county-level Social Vulnerability Index (SVI), a percentile-based measure of social vulnerability to disasters, its subcomponents and race/ethnic composition with COVID-19 incidence and mortality in the USA in the year starting in March 2020.
methodsCounties (n=3091) with ≥50 COVID-19 cases by 6 March 2021 were included in the study. Associations between SVI (and its subcomponents) and county-level racial composition with incidence and death per capita were assessed by fitting a negative-binomial mixed-effects model. This model was also used to examine potential time-varying associations between weekly number of cases/deaths and SVI or racial composition. Data were adjusted for percentage of population aged ≥65 years, state-level testing rate, comorbidities using the average Hierarchical Condition Category score, and environmental factors including average fine particulate matter of diameter ≥2.5 μm, temperature and precipitation.
resultsHigher SVI, indicative of greater social vulnerability, was independently associated with higher COVID-19 incidence (adjusted incidence rate ratio per 10 percentile increase: 1.02, 95% CI 1.02 to 1.03, p<0.001) and death per capita (1.04, 95% CI 1.04 to 1.05, p<0.001). SVI became an independent predictor of incidence starting from March 2020, but this association became weak or insignificant by the winter, a period that coincided with a sharp increase in infection rates and mortality, and when counties with higher proportion of white residents were disproportionately represented ('third wave'). By spring of 2021, SVI was again a predictor of COVID-19 outcomes. Counties with greater proportion of black residents also observed similar temporal trends in COVID-19-related adverse outcomes. Counties with greater proportion of Hispanic residents had worse outcomes throughout the duration of the analysis.
conclusionExcept for the winter 'third wave', when majority of the white communities had the highest incidence of cases, counties with greater social vulnerability and proportionately higher minority populations experienced worse COVID-19 outcomes.
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