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Area-Level Social Vulnerability and Severe COVID-19: A Case-Control Study Using Electronic Health Records from Multiple Health Systems in the Southeastern Pennsylvania Region
Mullachery, Pricila H. Bilal, Usama Li, Ran McClure, Leslie A.
Mullachery, Pricila H.
Bilal, Usama
Li, Ran
McClure, Leslie A.
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Journal article
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2024-05-13
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Health Services Administration and Policy
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https://doi.org/10.1007/s11524-024-00876-6
Abstract
Knowledge about neighborhood characteristics that predict disease burden can be used to guide equity-based public health interventions or targeted social services. We used a case-control design to examine the association between area-level social vulnerability and severe COVID-19 using electronic health records (EHR) from a regional health information hub in the greater Philadelphia region. Severe COVID-19 cases (n = 15,464 unique patients) were defined as those with an inpatient admission and a diagnosis of COVID-19 in 2020. Controls (n = 78,600; 5:1 control-case ratio) were a random sample of individuals who did not have a COVID-19 diagnosis from the same geographic area. Retrospective data on comorbidities and demographic variables were extracted from EHR and linked to area-level social vulnerability index (SVI) data using ZIP codes. Models adjusted for different sets of covariates showed incidence rate ratios (IRR) ranging from 1.15 (95% CI, 1.13–1.17) in the model adjusted for individual-level age, sex, and marital status to 1.09 (95% CI, 1.08–1.11) in the fully adjusted model, which included individual-level comorbidities and race/ethnicity. The fully adjusted model indicates that a 10% higher area-level SVI was associated with a 9% higher risk of severe COVID-19. Individuals in neighborhoods with high social vulnerability were more likely to have severe COVID-19 after accounting for comorbidities and demographic characteristics. Our findings support initiatives incorporating neighborhood-level social determinants of health when planning interventions and allocating resources to mitigate epidemic respiratory diseases, including other coronavirus or influenza viruses.
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Mullachery, P.H., Bilal, U., Li, R. et al. Area-Level Social Vulnerability and Severe COVID-19: A Case–Control Study Using Electronic Health Records from Multiple Health Systems in the Southeastern Pennsylvania Region. J Urban Health 101, 845–855 (2024). https://doi.org/10.1007/s11524-024-00876-6
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Springer Science and Business Media
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Journal of Urban Health, Vol. 101, Iss. 4
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Attribution CC BY