{"doi":"10.1101/2020.04.10.20060962","title":"Impact of Social Vulnerability on COVID-19 Incidence and Outcomes in the United States","abstract":"ABSTRACT Importance Prior pandemics have disparately affected socially vulnerable communities. Whether regional variations in social vulnerability to disasters influence COVID-19 outcomes and incidence in the U.S. is unknown. Objective To examine the association of Social Vulnerability Index (SVI), a percentile-based measure of county-level social vulnerability to disasters, and its sub-components (socioeconomic status, household composition, minority status, and housing type/transportation accessibility) with the case fatality rate (CFR) and incidence of COVID-19. Design Ecological study of counties with at least 50 confirmed COVID-19 cases as of April 4 th , 2020. Generalized linear mixed-effects models with state-level clustering were applied to estimate county-level associations of overall SVI and its sub-component scores with COVID-19 CFR (deaths/100 cases) and incidence (cases/1000 population), adjusting for population percentage aged ≥65 years, and for comorbidities using the average Hierarchical Condition Category (HCC) score. Counties with high SVI (≥median) and high CFR (≥median) were identified. Setting Population-based study of U.S. county-level data. Participants U.S. counties with at least 50 confirmed COVID-19 cases. Main outcomes and measures COVID-19 CFR and incidence. Results Data from 433 counties including 283,256 cases and 6,644 deaths were analyzed. Median SVI was 0.46 [Range: 0.01-1.00], and median CFR and incidence were 1.9% [Range: 0-13.3] and 1.2 per 1000 people [Range: 0.6-38.8], respectively. Higher SVI, indicative of greater social vulnerability, was associated with higher CFR (RR: 1.19 [1.05, 1.34], p=0.005, per-1 unit increase), an association that strengthened after adjustment for age≥65 years and comorbidities (RR: 1.63 [1.38, 1.91], p<0.001), and was further confirmed in a sensitivity analysis limited to six states with the highest testing levels. Although the association between overall SVI and COVID-19 incidence was not significant, the SVI sub-components of socioeconomic status and minority status were both predictors of higher incidence and CFR. A combination of high SVI (≥0.46) and high adjusted CFR (≥2.3%) was observed in 28.9% of counties. Conclusions and Relevance Social vulnerability is associated with higher COVID-19 case fatality. High social vulnerability and CFR coexist in more than 1 in 4 U.S. counties. These counties should be targeted by public policy interventions to help alleviate the pandemic burden on the most vulnerable population. KEY POINTS Question Is county-level social vulnerability to disasters associated with the case fatality rate (CFR) and incidence of SARS-CoV-2 infection during the COVID-19 pandemic in the U.S.? Findings Each unit increase in county-level social vulnerability, measured using the Social Vulnerability Index (SVI), was associated with a 63% higher CFR after adjusting for age and comorbidities. Both CFR and incidence of COVID-19 were significantly higher in counties with lower socio-economic status and higher proportion of minority populations. Meaning U.S. counties with higher social vulnerability are experiencing greater mortality rates during the COVID-19 pandemic.","journal":"medRxiv","year":2020,"id":118266,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":154,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9548,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2020-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":445438,"name":"Shabatun Islam","orcid":"0000-0002-0886-9021","position":1,"is_corresponding":false},{"id":445436,"name":"Anurag Mehta","orcid":"0000-0002-6910-5551","position":2,"is_corresponding":false},{"id":304836,"name":"Yi‐An Ko","orcid":"0000-0002-6543-9765","position":3,"is_corresponding":false},{"id":337637,"name":"Shivani A. Patel","orcid":"0000-0003-0082-5857","position":4,"is_corresponding":false},{"id":550183,"name":"Abhinav Goyal","orcid":"0000-0002-6286-2349","position":5,"is_corresponding":false},{"id":328663,"name":"Samaah Sullivan","orcid":"0000-0001-9427-7235","position":6,"is_corresponding":false},{"id":98920,"name":"Tené T. Lewis","orcid":null,"position":7,"is_corresponding":false},{"id":292487,"name":"Viola Vaccarino","orcid":"0000-0002-9054-0654","position":8,"is_corresponding":false},{"id":338686,"name":"Alanna A. Morris","orcid":"0000-0002-8033-3707","position":9,"is_corresponding":false},{"id":236696,"name":"Arshed A. Quyyumi","orcid":"0000-0002-8166-679X","position":10,"is_corresponding":false},{"id":338685,"name":"Aditi Nayak","orcid":"0000-0002-6986-0987","position":0,"is_corresponding":true}],"reference_count":14,"raw_metadata":null,"created_at":"2026-07-18T23:13:58.531532Z","pmid":"32511437","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}