Geography of Disparity: Connecting COVID-19 Vulnerability and Social Determinants of Health in Colorado

Abstract

The COVID-19 pandemic has drawn greater attention to social determinants of health and associated health inequities, which disproportionately affect vulnerable populations and places in the U.S. In this study, we explored geographic patterns of local-level COVID-19 vulnerability and associations with social and health determinants across Colorado. To conceptualize social and health determinants and how together they generate risk and exposure, we integrated the concepts of social vulnerability and syndemic to situate COVID-19 vulnerability within a broader hazards of place framework. Using geospatial statistics and GIS, we estimated census tract-level rates of COVID-19, which are not yet available in Colorado, and mapped areas of high and low incidence risk. We also developed composite indices that characterized social and health vulnerabilities to measure multivariate associations with COVID-19 rates. The findings revealed hotspots of persistent risk in mountain communities since the pandemic emerged in Colorado, as well as clusters of risk in the Urban Front Range’s central and southern counties, and across many parts of eastern Colorado. Vulnerability analyses indicate that COVID-19 rates were associated with mental health and chronic conditions along with social determinants that represent inequities in education, income, healthcare access, and race/ethnicity (minority percent of population), which may have disproportionately exposed some communities more than others to infection and severe health outcomes. Overall, the findings provide geographic health information about COVID-19 and vulnerability context, which may better inform local decision-making for interventions and policies that support equity of social determinants of health.

Supplemental data for this article is available online at https://doi.org/10.1080/08964289.2021.2021382 .

Keywords:

• COVID-19
• GIS
• social vulnerability
• social determinants of health
• syndemic
• health disparity

Acknowledgements

We would like to thank the anonymous reviewers and comments from the editors which helped to improve this manuscript.

Disclosure statement

No potential conflict of interest was reported by the authors.

Funding

This research did not receive external funding support.

Funding

The author(s) reported there is no funding associated with the work featured in this article.

Notes

1 The index is similar to one generated by Ramirez et al., using Cutter et al. methodology, to represent syndemic conditions, composed of several infectious diseases, in a local area in northern Peru.

2 The CDC-based SVI and its components do not fit neatly within the domains of the SODH. Nevertheless, there is enough overlap between the CDC concept and SODH, to allow for applications