Percentage of Black Population and Primary Care Shortage Areas Associated with Higher COVID-19 Case and Death Rates in Georgia Counties.
Percentage of Black Population and Primary Care Shortage Areas Associated with Higher COVID-19 Case and Death Rates in Georgia Counties.
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DOI：
10.14423/smj.0000000000001212
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发表时间：
2021-03
影响因子：
1.1
通讯作者：
Gaglioti AH
中科院分区：
文献类型：
--
作者：
Baltrus PT;Douglas M;Li C;Caplan LS;Blount M;Mack D;Gaglioti AH
作者研究了与佐治亚州2019年县级新型冠状病毒病病例和死亡率相关的因素。他们发现，即使在对社会生态和卫生系统因素进行调整后，县黑人人口百分比也与病例和死亡率都相关。即使调整了其他因素，初级保健专业人员短缺地区也与较高的新型冠状病毒死亡率相关。文本中提供了补充的数字内容。我们假设，即使在考虑了贫困、人口密度、家庭拥挤和未参保率等其他高风险社会生态因素后，一个县的黑人个人比例也将与2019年冠状病毒病(新冠肺炎)病例和死亡率的较高相关。我们还预计，被指定为初级保健专业人员短缺地区(PCHPSA)的县将与更高的新冠肺炎死亡率相关，而缺乏初级保健服务将加剧死亡率方面的种族差异。我们开展这项研究是为了验证这些假设，并了解种族构成、社会生态特征和医疗保健系统因素对佐治亚州各县新冠肺炎病例和死亡的独立影响。我们使用约翰霍普金斯冠状病毒资源中心2020年4月23日的县级新冠肺炎病例和死亡人数以及美国人口普查局对2019年县级人口的估计来计算佐治亚州的累积事件发生率。我们使用多元回归模型来检验社会生态和卫生系统变量与县级新冠肺炎病例和死亡率的粗略和调整后的相关性。调整后，该县黑人比例每增加1个百分点，该县新冠肺炎确诊病例数增加2.3个百分点，死亡率增加3.0个百分点(相对危险度1.0 3，95%可信区间1.01-1.0 5，P<；0.001)。初级保健短缺地区的死亡率高出74%(相对危险度1.74，95%可信区间1.00~3.00，P=0.049)。这些结果突显了种族差异对格鲁吉亚新冠肺炎疾病负担空间格局的影响，这可以指导缓解种族差异的干预措施。这些结果也支持了在全州范围内建立强大的初级保健基础设施的需求。
The authors examined the factors that were associated with county-level novel coronavirus disease 2019 case and death rates in the state of Georgia. They found that county percent Black population was associated with both case and death rates even after adjustment for socioecologic and health system factors. Primary care health professional shortage areas were associated with higher novel coronavirus death rates, even when adjusted for other factors. Supplemental digital content is available in the text. We hypothesized that the proportion of Black individuals in a county would be associated with higher rates of coronavirus disease 2019 (COVID-19) cases and deaths, even after accounting for other high-risk socioecologic factors such as poverty, population density, and household crowding, and uninsured rates. We also expected that counties designated as primary care health professional shortage areas (PCHPSAs) would be associated with higher COVID-19 death rates, and the lack of primary care access would exacerbate racial disparities in death rates. We undertook this study to test these hypotheses and discern the independent effects of racial composition, socioecologic characteristics, and healthcare system factors on COVID-19 cases and deaths in Georgia counties. We used county-level COVID-19 cases and deaths on April 23, 2020 from the Johns Hopkins Coronavirus Resource Center and estimates of 2019 county-level populations from the US Census Bureau to calculate the cumulative event rates for the state of Georgia. We used multiple regression models to examine crude and adjusted associations of socioecologic and health system variables with county-level COVID-19 case and mortality rates. After adjustment, a 1% increase in the proportion of Black people in the county resulted in a 2.3% increase in the county COVID-19 confirmed case rate and a 3.0% increase in the death rate (relative risk 1.03, 95% confidence interval 1.01–1.05, P < 0.001). Primary care shortage areas had a 74% higher death rate (relative risk 1.74, 95% confidence interval 1.00–3.00, P = 0.049). These results highlight the impact of racial disparities on the spatial patterns of COVID-19 disease burden in Georgia, which can guide interventions to mitigate racial disparities. The results also support the need for robust primary care infrastructure throughout the state.