The Dynamic Impact of Community Social Vulnerability on COVID-19 Outcomes: A Census Tract-level Analysis of Fulton County, Georgia.

Abstract

Coronavirus disease 2019 (COVID-19) case and death rates have been variable across geography and time; an understanding of community social vulnerability and variation in COVID-19 outcomes is needed to better respond to acute public health needs and prioritize post-pandemic recovery. We analyzed records of confirmed COVID-19 cases (N = 106 037) and deaths (N = 2107) in Fulton County, Georgia, from 4 March 2020 to 11 November 2021. We developed the social vulnerability index-plus (SVI+) as a composite measure of 19 census tract-level social and health indicators summarizing community vulnerability. Ecological analyses included linear regression estimates of differences in weekly COVID-19 case and death rates per 100 000 population by SVI+ across 201 census tracts. Multilevel analyses included log-binomial regression estimates of relative risk of individual-level death among confirmed cases according to the SVI+. Calendar periods included Pre-Vaccine (March 2020 to 15 December 2020), Post-Vaccine/Pre-Delta variant surge (16 December 2020 to 30 June 2021), and post-vaccine/Delta variant surge (1 July 2021 to 11 November 2021). We observed a positive association between SVI+ and both COVID-19 census tract-level case and death rates. Analyses by calendar period indicated that the strongest association between SVI+ and both case rates, and death rates was in the post-vaccine/Delta variant surge period. Analyses of individual-level death among cases showed a positive association between SVI+ and COVID-19 death after accounting for age, race, and sex. SVI+ and individual-level death were positively associated in all calendar periods. Even after vaccine availability, communities with higher social vulnerability experienced worse COVID-19 outcomes. The findings reiterate the importance of addressing social determinants by increasing public health efforts in vulnerable communities to mitigate health disparities in future pandemics.