Mohamed Mubasher *, Lynnette Ametewee, Reinetta Thompson Waldrop, Peter Baltrus, Sabrina Mobley, Rakale C. Quarells, Michelle Nwagwu, Chanelle Harris, Kamaria Glover, Mekhi Hill, Brittany D. Taylor and Tabia Henry Akintobi

Abstract:

Introduction: The novel coronavirus (COVID-19) continues to highlight the disproportionately negative impact of public health pandemics on racial/ethnic minorities and other systematically marginalized communities, which consistently experience poorer health and health outcomes. Far less statistical investigation has been conducted to confirm the disease-agnostic social determinants correlated with the intersection of emergent crises, chronic health conditions, and local contexts to inform proactive response strategies. This study investigated the influence of Social Vulnerability (SV), barriers to access to vaccination, and Racial Disparities (RD) on COVID-19 infection and death rates among Georgian residents, using data from the Georgia Department of Public Health and County Health Rankings & Roadmaps.

Method: We adjusted analyses for other predictors of outcomes using Poisson Generalized Linear Mixed Models, with county as the unit of analysis. We iteratively modeled county-specific infection and death rates as a function of the Social Vulnerability Index (SVI), % Racial Population Gap (RPG) [(60+ years % White – % African Americans/Blacks (AA)/Black)], education, % unemployed, % uninsured, % obese, % fully vaccinated, racial differences in respiratory infection discharge rates, and % AA/Black residents (excluding RPG in the model).

Results: The adjusted models’ results for COVID-19-related deaths showed the following:

• I) AA/Blacks, relative to Whites, were 51% more likely to die (p-value < 0.0001):
  • 1. Age-specific and overall estimates (p-values < 0.0001).
  • 2. AA/Blacks died at a younger mean age (p-value < 0.0001).
• II) A 1% increase in SVI increased the risk of death by 25% (p-value < 0.0001).
• III) The risk of death decreased by 2.3% for every 1% increase in 60+ years old Whites vs. Black males in county residents (p-value < 0.0001).

Regarding the case infection rate:

• a.1) It decreased by 0.1% for every percent population increase in the racial gap (i.e., more Whites than AA/Blacks in a county) (p-value = 0.0122).
• a.2) It decreased by 27% for every 1% increase in those fully vaccinated (p-value < 0.0001).
• The rates also increased by:
  • a) 17% for every 1% increase in the SV Index (p-value < 0.0001).
  • b) 1% for every 0.1% increase in those:
    • a) Obese (p-value < 0.0001).
    • b) Uninsured (p-value < 0.0001).