County-Level Assessment of Vulnerability to COVID-19 in Alabama

Abstract

The COVID-19 pandemic has posed an unprecedented challenge to public health across the world and has further exposed health disparities and the vulnerability of marginal groups. Since the pandemic has exhibited marked regional differences, it is necessary to better understand the levels of vulnerability to the disease at local levels and provide policymakers with additional tools that will allow them to develop finely targeted policies. In this study, we develop for the State of Alabama (USA) a composite vulnerability index at county level that can be used as a tool that will help in the management of the pandemic. Twenty-four indicators were assigned to the following three categories: exposure, sensitivity, and adaptive capacity. The resulting subindices were aggregated into a composite index that depicts the vulnerability to COVID-19. A multivariate analysis was used to assign factor loadings and weights to indicators, and the results were mapped using Geographic Information Systems. The vulnerability index captured health disparities very well. Many of the most vulnerable counties were found in the Alabama Black Belt region. A deconstruction of the overall index and subindices allowed the development of individual county profiles and the detection of local strengths and weaknesses. We expect the model developed in this study to be an efficient planning tool for decision-makers.

Differential Urban Heat Vulnerability: The Tale of Three Alabama Cities

“…The statistical analysis steps are shown in Figure 3. The procedures used in this study are described in detail by Fall et al [108]. Factor analysis (FA) with varimax rotation was used to assign weights to variables for two subindices: sensitivity and adaptive capacity.…”

“…In this study, vulnerability is considered as a function of three determinants: exposure, sensitivity, and adaptive capacity. This framework, presented by the Intergovernmental Panel on Climate Change in its third Assessment Report [103], is widely used, as attested by many studies [104][105][106][107][108][109][110]. Exposure and sensitivity represent the potential impacts of a hazard (here, urban heat), while adaptive capacity denotes the ability of a system to use its resources and institutions to adapt, mitigate, and cope with impacts.…”

Incorporating resilience when assessing pandemic risk in the Arctic: a case study of Alaska

“…Furthermore, vulnerability indices have also been used as a tool to highlight disparities in COVID-19 vaccination coverage and vaccine hesitancy 18–20. One consistent thread found in these studies is the development or modification of the vulnerability indices using simple to sophisticated statistical methods such as arithmetic mean,16 percentile ranking,11 15 regression analysis,14 17 18 principal component analysis,12 factor analysis,9 machine learning algorithms,10 13 etc. The common societal indicators used by these studies to develop the indices include age, poverty, race or ethnicity, education, population with comorbidities, overcrowded households, and hospital density, among others.…”

“…In the context of the COVID-19 pandemic, numerous studies have assessed vulnerability through various indices calculated using a confluence of societal factors. [9][10][11][12][13][14][15][16][17] Most of these studies examine the relationship between the vulnerability index and COVID-19 outcomes and discover that highly vulnerable areas have higher COVID-19 incidence and mortality rates. Furthermore, vulnerability indices have also been used as a tool to highlight disparities in COVID-19 vaccination coverage and vaccine hesitancy.…”

“…In the context of the COVID-19 pandemic, numerous studies have assessed vulnerability through various indices calculated using a confluence of societal factors 9–17. Most of these studies examine the relationship between the vulnerability index and COVID-19 outcomes and discover that highly vulnerable areas have higher COVID-19 incidence and mortality rates.…”