ORIGINAL ARTICLE
The Association of Social Determinants of Health With COVID-19 Mortality in Rural and Urban Counties
Rajib Paul PhD,
Ahmed Arif MBBS, PhD,
Kamana Pokhrel MS,
Subhanwita Ghosh MS,
Corresponding Author
Rajib Paul PhD
Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, North Carolina, USA
Correspondence
Rajib Paul, PhD, Department of Public Health Sciences, University of North Carolina at Charlotte, 9201 University City Blvd., Charlotte, NC 28223, USA.
Email: [email protected]
Search for more papers by this authorAhmed Arif MBBS, PhD
Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, North Carolina, USA
Search for more papers by this authorKamana Pokhrel MS
Health Analytics and Informatics, University of North Carolina at Charlotte, Charlotte, North Carolina, USA
Search for more papers by this authorSubhanwita Ghosh MS
Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, North Carolina, USA
Search for more papers by this authorRajib Paul PhD,
Ahmed Arif MBBS, PhD,
Kamana Pokhrel MS,
Subhanwita Ghosh MS,
Corresponding Author
Rajib Paul PhD
Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, North Carolina, USA
Correspondence
Rajib Paul, PhD, Department of Public Health Sciences, University of North Carolina at Charlotte, 9201 University City Blvd., Charlotte, NC 28223, USA.
Email: [email protected]
Search for more papers by this authorAhmed Arif MBBS, PhD
Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, North Carolina, USA
Search for more papers by this authorKamana Pokhrel MS
Health Analytics and Informatics, University of North Carolina at Charlotte, Charlotte, North Carolina, USA
Search for more papers by this authorSubhanwita Ghosh MS
Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, North Carolina, USA
Search for more papers by this authorFunding: Rajib Paul's work was partially supported by the National Foundation, Division of Civil, Mechanical and Manufacturing Innovation (CMMI) award # 1537379.
Abstract
Purpose
To identify the county-level effects of social determinants of health (SDoH) on COVID-19 (corona virus disease 2019) mortality rates by rural–urban residence and estimate county-level exceedance probabilities for detecting clusters.
Methods
The county-level data on COVID-19 death counts as of October 23, 2020, were obtained from the Johns Hopkins University. SDoH data were collected from the County Health Ranking and Roadmaps, the US Department of Agriculture, and the Bureau of Labor Statistics. Semiparametric negative binomial regressions with expected counts based on standardized mortality rates as offset variables were fitted using integrated Laplace approximation. Bayesian significance was assessed by 95% credible intervals (CrI) of risk ratios (RR). County-level mortality hotspots were identified by exceedance probabilities.
Findings
The COVID-19 mortality rates per 100,000 were 65.43 for the urban and 50.78 for the rural counties. Percent of Blacks, HIV, and diabetes rates were significantly associated with higher mortality in rural and urban counties, whereas the unemployment rate (adjusted RR = 1.479, CrI = 1.171, 1.867) and residential segregation (adjusted RR = 1.034, CrI = 1.019, 1.050) were associated with increased mortality in urban counties. Counties with a higher percentage of college or associate degrees had lower COVID-19 mortality rates.
Conclusions
SDoH plays an important role in explaining differential COVID-19 mortality rates and should be considered for resource allocations and policy decisions on operational needs for businesses and schools at county levels.
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