The study shows more COVID deaths were reported in US counties with less internet access


U.S. communities with limited internet access had higher COVID-19 death rates in the first full year of the pandemic, researchers say.

In a study published earlier this month in the journal JAMA Network Open, authors from the University of Chicago wrote that places with more restricted access could prevent between 2.4 and six deaths per 100,000 people, depending on whether they are in the countryside, in live in the suburbs or in the city.

“Adopting an asset-based approach, we believe this result suggests that there is a need for more awareness of the essential advantage of technological access to reliable information, remote work, school opportunities, resource purchasing and/or social community. Population groups with limited internet access remain understudied and are often excluded from pandemic research,” the researchers said written down.

By analyzing the Centers for Disease Control and Prevention (CDC) mortality data for all US counties in 50 states and the District of Columbia reported from January 22, 2020 to February 28, 2021, the group identified counties with one high concentration of a single racial and ethnic population and high levels of COVID-19 mortality as “concentrated longitudinal impact districts”.

Other racial and ethnic demographics were obtained from publicly available datasets.

The social determinants of health (SDOH) that might be associated with county mortality were examined, with researchers focusing on Black, Hispanic, and non-Hispanic White Americans in rural, suburban, or urban areas.

Four indices were used to measure multiple dimensions of SDOH: a socioeconomic Advantage Index, Reduced Mobility Index, Urban Core Opportunities Index and mixed Immigrant Cohesion and Accessibility Index.

Using models to examine associations between the SDOH and the COVID-19 mortality rate at the county level, they found that 531 counties out of 3,142 were identified as counties with concentrated longitudinal impacts.

Of these counties, 347 had large Black American populations, 198 had large Hispanic populations, and 33 had large non-Hispanic White populations.

In addition, almost 490,000 deaths related to COVID-19 have been reported.

“The most concentrated longitudinal impact counties with large Black or African American populations relative to other counties were spread across urban, suburban, and rural areas and had numerous disadvantages, including higher income inequality and more avoidable hospitalizations. Most concentrated longitudinal impact counties with large Hispanic or Latino populations compared to other counties were in urban areas, and 130 of these counties had high percentages of people without health insurance. Most concentrated longitudinal impact counties with large non-Hispanic white populations compared to other counties were located in rural areas, included a large population of older adults, and had limited access to quality health care,” the study concluded.

In urban areas, the mixed cohesion and accessibility index of immigrants was inversely associated with COVID-19 mortality, and higher COVID-19 mortality rates were also associated with avoidable hospitalizations in rural areas and higher vulnerability to socioeconomic status in suburban areas.

In most concentrated longitudinal impact counties with large black or Hispanic populations compared to other counties, rates of severe housing problems were higher than the national median, and the most concentrated longitudinal impact counties with large black and non-Hispanic white populations had higher percentages of households without internet access.

The study’s findings, they said, underscore how places and people intersect within the multifaceted power structures that create and reproduce inequalities in health outcomes.

“Clearly, SDOH dimensions are important to health outcomes, but the results of this study nuance this assumption by showing that SDOH may affect health in unique ways, depending on a community’s rural and urban contexts as well as its racial and ethnic makeup .” wrote the authors. “We found that non-Hispanic White populations in rural areas and Hispanic or Hispanic populations in urban areas were particularly vulnerable to mortality from COVID-19, while Black or African American populations in rural and urban contexts (in terms of mortality rate) meanwhile fared poorly in the first year of the pandemic. For urban, rural, and suburban communities, some dimensions of SDOH appeared more consequential to COVID-19 death rates, pointing to the social levers that may play the biggest role in getting the population health needle in different types of communities.”

The limitations of their study include that it excluded analyzes for other racial and ethnic groups, that the cross-sectional study used an exploratory approach to spatial data analysis, that the county-level scale may not capture the full picture of the affected population, that there is the potential confounder of vaccines available in late 2020 and that they primarily analyzed SDOH barriers related to susceptibility to COVID-19 mortality.

To address health inequalities and guide policies and programs, they called for further studies. The study shows more COVID deaths were reported in US counties with less internet access


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