ArticleClinical infectious diseases : an official publication of the Infectious Diseases Society of America2025
The Dynamic Impact of Community Social Vulnerability on COVID-19 Outcomes: A Census Tract-level Analysis of Fulton County, Georgia.
Article in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundCoronavirus disease 2019 (COVID-19) case and death rates have been variable across geography and time; an understanding of community social vulnerability and variation in COVID-19 outcomes is needed to better respond to acute public health needs and prioritize post-pandemic recovery.
methodsWe analyzed records of confirmed COVID-19 cases (N = 106 037) and deaths (N = 2107) in Fulton County, Georgia, from 4 March 2020 to 11 November 2021. We developed the social vulnerability index-plus (SVI+) as a composite measure of 19 census tract-level social and health indicators summarizing community vulnerability. Ecological analyses included linear regression estimates of differences in weekly COVID-19 case and death rates per 100 000 population by SVI+ across 201 census tracts. Multilevel analyses included log-binomial regression estimates of relative risk of individual-level death among confirmed cases according to the SVI+. Calendar periods included Pre-Vaccine (March 2020 to 15 December 2020), Post-Vaccine/Pre-Delta variant surge (16 December 2020 to 30 June 2021), and post-vaccine/Delta variant surge (1 July 2021 to 11 November 2021).
resultsWe observed a positive association between SVI+ and both COVID-19 census tract-level case and death rates. Analyses by calendar period indicated that the strongest association between SVI+ and both case rates, and death rates was in the post-vaccine/Delta variant surge period. Analyses of individual-level death among cases showed a positive association between SVI+ and COVID-19 death after accounting for age, race, and sex. SVI+ and individual-level death were positively associated in all calendar periods.
conclusionsEven after vaccine availability, communities with higher social vulnerability experienced worse COVID-19 outcomes. The findings reiterate the importance of addressing social determinants by increasing public health efforts in vulnerable communities to mitigate health disparities in future pandemics.
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