Abstract
INTRODUCTION: The novel coronavirus (COVID-19) continues to shed light on the disproportionately negative impact of public health pandemics among racial/ethnic minorities and other systematically marginalized communities persistency experiencing 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 crisis, 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 Georgia Department of Public Health data and County Health Rankings & Roadmaps. METHOD: We adjusted analyses for other predictors of outcomes by using the Poisson Generalized Linear Mixed Models (with county as the unit of analysis). We iteratively modeled county-specific infection/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 (w/o RPG in the model). RESULTS: Per adjusted models' results of COVID-19 related death,, I) AA/Blacks, relative to Whites, were 51% more likely to die (p-value <0.0001), 1) by age-specific and overall estimates(p-values <0.0001 and 2) at a younger mean age (p-value < 0.0001), II) 1% increase in SVI increases the risk of death by 25% (p-value <0.0001) and III) risk of death decreases by 2.3% for every % increase in 60+ years old Whites vs. Black males county residents (p-value <0.0001). The case infection rate a) decreased by a.1) 0.1% for every percent population increase in the racial gap (i.e., more Whites than AA/Blacks in a county) (p-values = 0.0122) and a.2) 27% for every % increase of those fully vaccinated(p-value < 0.0001). The rates also increased by a) 17% with every 1% increase in SV Index p-value <0.0001) b) 1% for every 0.1% increase in those a) obese (p-value < 0.0001) and b) uninsured (p-value < 0.0001). CONCLUSIONS: Attention to the Social Vulnerability Index (SVI) factors associated with COVID-19 illness and death signal the need for proactive prevention and mitigation interventions prior to and in the wake of public health pandemics thereby bridging the health disparity gap.