Who Gets Sick from COVID-19? Sociodemographic Correlates of Severe Adult Health Outcomes During Alpha- and Delta-Variant Predominant Periods, 9/2020–11/2021
Stanley C Wei, Dane Freeman, Austin Himschoot, Kristie E N Clarke, Miriam E Van Dyke, Jennifer Adjemian, Farida B Ahmad, Tina J Benoit, Kevin Berney, Adi V Gundlapalli, Aron J Hall, Fiona Havers, S Jane Henley, Charity Hilton, Dylan Johns, Jean D Opsomer, Huong T Pham, Matthew J Stuckey, Christopher A Taylor, Jefferson M Jones- Infectious Diseases
- Immunology and Allergy
Abstract
Background
Because COVID-19 case data do not capture most SARS-CoV-2 infections, the actual risk of severe disease and death per infection is unknown. Integrating sociodemographic data into analysis can show consequential health disparities.
Methods
Data from September 2020–November 2021 from six national surveillance systems in matched geographical areas were merged and analyzed to estimate numbers of COVID-19-associated cases, emergency department visits, and deaths per 100,000 infections. Relative risks of outcomes per infection were compared by sociodemographic factors in a dataset including 1,490 counties from 50 states and the District of Columbia, covering 71% of the US population.
Results
Per infection with SARS-CoV-2, COVID-19-related morbidity and mortality were higher among non-Hispanic American Indian and Alaska Native persons, non-Hispanic Black persons, and Hispanic or Latino persons compared with non-Hispanic White persons, males compared with females, older persons compared with younger, persons in more socially vulnerable counties compared with less, persons in large central metro areas compared with rural areas, and persons in the South compared with the Northeast.
Discussion
Meaningful disparities in COVID-19 morbidity and mortality per infection were associated with sociodemography and geography. Addressing these disparities could have helped prevent the loss of tens of thousands of lives.