Comorbidities, sociodemographic factors, and determinants of health on COVID-19 fatalities in the United States

Abstract

Previous studies have evaluated comorbidities and sociodemographic factors individually or by type but not comprehensively. This study aims to analyze the influence of a wide variety of factors in a single study to better understand the big picture of their effects on case-fatalities. This cross-sectional study used county-level comorbidities, social determinants of health such as income and race, measures of preventive healthcare, age, education level, average household size, population density, and political voting patterns were all evaluated on a national and regional basis. Analysis was performed through Generalized Additive Models and adjusted by the COVID-19 Community Vulnerability Index (CCVI). Effect estimates of COVID-19 fatality rates for risk factors such as comorbidities, sociodemographic factors and determinant of health. Factors associated with reducing COVID-19 fatality rates were mostly sociodemographic factors such as age, education and income, and preventive health measures. Obesity, minimal leisurely activity, binge drinking, and higher rates of individuals taking high blood pressure medication were associated with increased case fatality rate in a county. Political leaning influenced case case-fatality rates. Regional trends showed contrasting effects where larger household size was protective in the Midwest, yet harmful in Northeast. Notably, higher rates of respiratory comorbidities such as asthma and chronic obstructive pulmonary disease (COPD) diagnosis were associated with reduced case-fatality rates in the Northeast. Increased rates of chronic kidney disease (CKD) within counties were often the strongest predictor of increased case-fatality rates for several regions. Our findings highlight the importance of considering the full context when evaluating contributing factors to case-fatality rates. The spectrum of factors identified in this study must be analyzed in the context of one another and not in isolation.

Association Between Partisan Affiliation of State Governments and State Mortality Rates Before and During the COVID‐19 Pandemic

“…The simplest explanation for this loss of statistical significance is that low income (and its adverse influences on risk factors for disease) exerted greater influence on mortality than the policy choices of state officials or their party affiliation. Other studies have documented higher COVID‐19 mortality in counties with adverse socioeconomic conditions 36–38 . However, the potentially complex relationships among the variables measured in this study allow for more nuanced explanations.…”

“…Other studies have documented higher COVID-19 mortality in counties with adverse socioeconomic conditions. [36][37][38] However, the potentially complex relationships among the variables measured in this study allow for more nuanced explanations. For example, labor market or tax policies that widen wealth inequality and disadvantage lower-or middle-income households can reduce growth in median household income.…”

Association between Average Vitamin D Levels and COVID-19 Mortality in 19 European Countries—A Population-Based Study

“…Having said this, maintaining a healthy, balanced nutritional status is also important for individuals to overcome potential COVID-19 infection [61]. In addition, the health benefits of safe outdoor activity were also suggested [62], given that at least one of the health benefits of such activity is that it is one of the best ways to raise vitamin D levels [63].…”

Impact of sociodemographic factors on COVID-19 survival: a nationwide 2,000,000 in-patients’ cohort in Brazil

“…The more obscure prognosis of COVID-19 is directly related to the late detection of symptoms and associated comorbidities, especially those associated with microvascular and pulmonary complications 5 . However, the role of social determinants in the early detection of symptoms, as well as in the occurrence of chronic conditions such as heart disease, diabetes, and obesity, is remarkable.…”