Percentage of Black Population and Primary Care Shortage Areas Associated with Higher COVID-19 Case and Death Rates in Georgia Counties. Issue 2 (February 2021)

• Record Type: Journal Article
• Authors: Baltrus, Peter T.; Douglas, Megan; Li, Chaohua; Caplan, Lee S.; Blount, Mitchell; Mack, Dominic; Gaglioti, Anne H.
• Is Part Of: Southern medical journal. Volume 114:Issue 2(2021)
• Publication Date: 2021-02
• Subjects: COVID-19 -- ecologic analysis -- primary care -- racial disparities; Medicine -- Periodicals; 610.5
• DOI: 10.14423/SMJ.0000000000001212
• Languages: English
• ISSNs: 0038-4348

Abstract

Abstract : Objectives: 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. Methods: 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. Results: 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). Conclusions: 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. Abstract : 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.