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Social determinants of mortality from COVID-19: A simulation study using NHANES.
- Source :
-
PLoS medicine [PLoS Med] 2021 Jan 11; Vol. 18 (1), pp. e1003490. Date of Electronic Publication: 2021 Jan 11 (Print Publication: 2021). - Publication Year :
- 2021
-
Abstract
- Background: The COVID-19 epidemic in the United States is widespread, with more than 200,000 deaths reported as of September 23, 2020. While ecological studies show higher burdens of COVID-19 mortality in areas with higher rates of poverty, little is known about social determinants of COVID-19 mortality at the individual level.<br />Methods and Findings: We estimated the proportions of COVID-19 deaths by age, sex, race/ethnicity, and comorbid conditions using their reported univariate proportions among COVID-19 deaths and correlations among these variables in the general population from the 2017-2018 National Health and Nutrition Examination Survey (NHANES). We used these proportions to randomly sample individuals from NHANES. We analyzed the distributions of COVID-19 deaths by race/ethnicity, income, education level, and veteran status. We analyzed the association of these characteristics with mortality by logistic regression. Summary demographics of deaths include mean age 71.6 years, 45.9% female, and 45.1% non-Hispanic white. We found that disproportionate deaths occurred among individuals with nonwhite race/ethnicity (54.8% of deaths, 95% CI 49.0%-59.6%, p < 0.001), individuals with income below the median (67.5%, 95% CI 63.4%-71.5%, p < 0.001), individuals with less than a high school level of education (25.6%, 95% CI 23.4% -27.9%, p < 0.001), and veterans (19.5%, 95% CI 15.8%-23.4%, p < 0.001). Except for veteran status, these characteristics are significantly associated with COVID-19 mortality in multiple logistic regression. Limitations include the lack of institutionalized people in the sample (e.g., nursing home residents and incarcerated persons), the need to use comorbidity data collected from outside the US, and the assumption of the same correlations among variables for the noninstitutionalized population and COVID-19 decedents.<br />Conclusions: Substantial inequalities in COVID-19 mortality are likely, with disproportionate burdens falling on those who are of racial/ethnic minorities, are poor, have less education, and are veterans. Healthcare systems must ensure adequate access to these groups. Public health measures should specifically reach these groups, and data on social determinants should be systematically collected from people with COVID-19.<br />Competing Interests: The authors have declared that no competing interests exist.
- Subjects :
- Aged
Comorbidity
Ethnicity statistics & numerical data
Female
Health Services Needs and Demand
Humans
Male
Mortality
Quality Improvement organization & administration
SARS-CoV-2 isolation & purification
United States
Veterans Health statistics & numerical data
COVID-19 mortality
Healthcare Disparities standards
Public Health methods
Public Health standards
Social Determinants of Health statistics & numerical data
Socioeconomic Factors
Subjects
Details
- Language :
- English
- ISSN :
- 1549-1676
- Volume :
- 18
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- PLoS medicine
- Publication Type :
- Academic Journal
- Accession number :
- 33428624
- Full Text :
- https://doi.org/10.1371/journal.pmed.1003490