TY - JOUR
T1 - Amplified effect of social vulnerability on health inequality regarding COVID-19 mortality in the USA: The mediating role of vaccination allocation
AU - Chen, Ying
AU - Zhang, Lanwei
AU - Li, Tenglong
AU - Li, Li
PY - 2022
Y1 - 2022
N2 - Background: Vaccination reduces the overall burden of COVID-19, while its allocation procedure may introduce additional health inequality, given thatsince populations characterized with certain social vulnerabilities have received less vaccination and been affected more by COVID-19. We used This study, on the basis of structural equation modeling, aimed to quantitatively evaluate the extent to which vaccination disparity would amplify health inequality, where it functioned as a mediator in the effect pathways from social vulnerabilities to COVID-19 mortality.
Methods: We used USA nationwide county(n=3112, 99% of the total) level data during 2021 in an ecological study design. This was a USA nationwide study of ecological epidemiology at the county-level (n=3112, 99% of the total). Theme-specific rankings of social vulnerability index published by CDC (latest data of 2018, including socioeconomic status, household composition & disability, minority status & language, and housing type & transportation) were the exposure variables. Vaccination coverage rate (VCR) during of 2021 published by CDC was the mediator variable, while COVID-19 case fatality rate (CFR) of during 2021 published by John Hopkinson University, the outcome variable.
Results: Greater vulnerabilities in socioeconomic status, household composition & disability, and minority status & language were inversely associated with VCR, together explaining 11.3% of the variance of VCR. Greater vulnerabilities in socioeconomic status and household composition & disability were positively associated with CFR, while VCR was inversely associated with CFR, together explaining 10.4% of the variance of CFR. Our mediation analysis, based on the mid-year data (30th June 2021), found that 37.6% (mediation/total effect, 0.0014/0.0037), 10% (0.0003/0.0030) and 100% (0.0005/0.0005) of the effects in the pathways involving socioeconomic status, household composition & disability and minority status & language, respectively, were mediated by VCR. As a whole, the mediation effect significantly counted for 30.6% of COVID-19 CFR disparity. Such a mediation effect was seen throughout 2021, with proportions ranging from 12% to 32%.
Conclusions: Allocation of COVID-19 vaccination in the USA during in 2021 led to additional inequality regarding with respect to COVID-19 mortality. Viable public health interventions should be taken to guarantee an equitable deployment of healthcare recourses across different population groups.
AB - Background: Vaccination reduces the overall burden of COVID-19, while its allocation procedure may introduce additional health inequality, given thatsince populations characterized with certain social vulnerabilities have received less vaccination and been affected more by COVID-19. We used This study, on the basis of structural equation modeling, aimed to quantitatively evaluate the extent to which vaccination disparity would amplify health inequality, where it functioned as a mediator in the effect pathways from social vulnerabilities to COVID-19 mortality.
Methods: We used USA nationwide county(n=3112, 99% of the total) level data during 2021 in an ecological study design. This was a USA nationwide study of ecological epidemiology at the county-level (n=3112, 99% of the total). Theme-specific rankings of social vulnerability index published by CDC (latest data of 2018, including socioeconomic status, household composition & disability, minority status & language, and housing type & transportation) were the exposure variables. Vaccination coverage rate (VCR) during of 2021 published by CDC was the mediator variable, while COVID-19 case fatality rate (CFR) of during 2021 published by John Hopkinson University, the outcome variable.
Results: Greater vulnerabilities in socioeconomic status, household composition & disability, and minority status & language were inversely associated with VCR, together explaining 11.3% of the variance of VCR. Greater vulnerabilities in socioeconomic status and household composition & disability were positively associated with CFR, while VCR was inversely associated with CFR, together explaining 10.4% of the variance of CFR. Our mediation analysis, based on the mid-year data (30th June 2021), found that 37.6% (mediation/total effect, 0.0014/0.0037), 10% (0.0003/0.0030) and 100% (0.0005/0.0005) of the effects in the pathways involving socioeconomic status, household composition & disability and minority status & language, respectively, were mediated by VCR. As a whole, the mediation effect significantly counted for 30.6% of COVID-19 CFR disparity. Such a mediation effect was seen throughout 2021, with proportions ranging from 12% to 32%.
Conclusions: Allocation of COVID-19 vaccination in the USA during in 2021 led to additional inequality regarding with respect to COVID-19 mortality. Viable public health interventions should be taken to guarantee an equitable deployment of healthcare recourses across different population groups.
M3 - Article
C2 - 36402963
SN - 1471-2458
JO - BMC Public Health
JF - BMC Public Health
ER -
SDG 3 Good Health and Well-being