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Cited by 18Vaccine Coverage and HesitancyCOVID-19 epidemiological studiesHealth disparities and outcomes

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Amplified effect of social vulnerability on health inequality regarding COVID-19 mortality in the USA: the mediating role of vaccination allocation

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Chen, Ying, Zhang, Lanwei, Li, Tenglong, Li, Li·2022·BMC Public Health
DOI 10.1186/s12889-022-14592-wPMC PMC9675971
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Abstract

Background: Vaccination reduces the overall burden of COVID-19, while its allocation procedure may introduce additional health inequality, since populations characterized with certain social vulnerabilities have received less vaccination and been affected more by COVID-19. We used structural equation modeling 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. 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 2021 published by CDC was the mediator variable, while COVID-19 case fatality rate (CFR) 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 (30 th 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 2021 led to additional inequality 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.

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Fig. 1 The vaccination coverage rate and case fatality rate of COVID-19 in USA during 2021
Fig. 1 The vaccination coverage rate and case fatality rate of COVID-19 in USA during 2021CC BY · PubMed Central
Fig. 2 Vaccination coverage rate as a mediator in the impact pathway between certain themes of social vulnerability index and case fatality rate of COVID-19
Fig. 2 Vaccination coverage rate as a mediator in the impact pathway between certain themes of social vulnerability index and case fatality rate of COVID-19CC BY · PubMed Central
Fig. 3 The direct, mediation (indirect) and total effects calculated monthly over the year of 2021
Fig. 3 The direct, mediation (indirect) and total effects calculated monthly over the year of 2021CC BY · PubMed Central

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Metadata

Authors
Chen, Y., Zhang, L., Li, T., & Li, L.
Affiliations
Xi’an Jiaotong-Liverpool University (CN)
Corresponding author
Chen, Ying
ORCID
Venue
BMC Public Health
Publisher
Springer Science and Business Media LLC
Published
2022-11-19
Volume
22
Issue
1
Pages
2131-2131
ISSN
1471-2458 (ISSN-L)
DOI
10.1186/s12889-022-14592-w
PMC
PMC9675971
OpenAlex
W4309562637
Cited by
18
References
3
Citations by year
2026: 5 · 2025: 3 · 2024: 4 · 2023: 6
FWCI
2.50
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Public Health (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
Topics
  • Social Sciences › Health › Vaccine Coverage and Hesitancy
  • Physical Sciences › Mathematics › Modeling and Simulation › COVID-19 epidemiological studies
  • Social Sciences › Health › Health disparities and outcomes
Keywords
health disparities, social vulnerability, COVID-19 mortality, case fatality rate, vaccination coverage, socioeconomic status, minority status, health equity, mediation analysis
MeSH terms
COVID-19, COVID-19 Vaccines, Social Vulnerability, Humans, Socioeconomic Factors, United States, Vaccination, Health Status Disparities

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Chen, Y., Zhang, L., Li, T., & Li, L. (2022). Amplified effect of social vulnerability on health inequality regarding COVID-19 mortality in the USA: the mediating role of vaccination allocation. BMC Public Health. https://doi.org/10.1186/s12889-022-14592-w