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States with the populations most vulnerable to COVID-19

  • States with the populations most vulnerable to COVID-19

    Some communities and people are more vulnerable to the novel coronavirus not only because of underlying health conditions or age, but also because of where they live, where they work, their access to health care, their earnings, and the discrimination they face. These and other social determinants of health influence who gets affected by COVID-19 and how.

    In counties across the country, people of color are dying at higher rates than white people. In several states, people over 65 represent a larger share of COVID-19 cases and deaths relative to their share of the population, as nursing homes across the country have experienced outbreaks.

    To identify communities more vulnerable to the pandemic, the Surgo Foundation released the COVID-19 Community Vulnerability Index (CCVI) in April. The CCVI defines “more vulnerable” communities as those which “have a limited ability to mitigate, treat, and delay transmission of a pandemic disease, and to reduce its economic and social impacts.”

    The index uses six “themes,” or groups of indicators; four themes are adopted from the Center for Disease Control and Prevention’s Social Vulnerability Index, which measures a community’s resilience from all types of natural disaster from a socio-demographic perspective, and the remaining two themes (epidemiological factors and health care system factors) have been compiled by Surgo Foundation researchers specifically to address COVID-19. The data used to calculate scores comes from 2014–2018, depending on the indicator. The index’s full methodology (including sources for all indicators) is available here.

    In this story, Stacker lays out the CCVI scores for each state, as well as each state’s two biggest areas of vulnerability (i.e. themes which received the highest scores) and two specific indicators that contributed to each of those areas. Scores range from 0 to 1, and a higher value indicates a more vulnerable population. CCVI scores above 0.6 indicate high- to very-high-vulnerability communities.

    Read on to see which states are more vulnerable and why.

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  • #51. New Hampshire

    - Overall CCVI score: 0.00
    - #1 biggest area of vulnerability: Housing type & transportation (score: 0.38)
    --- 60,250 housing structures with 10+ units (9.5%)
    --- 27,300 households with no vehicle available (5.2% of all households)
    - #2 biggest area of vulnerability: Epidemiological factors (score: 0.36)
    --- 30% of adults have high blood pressure
    --- 13.2% of adults have asthma

    While New Hampshire is far from the most vulnerable to COVID-19, its older population inherently brings greater risk. Individuals living in crowded housing may find it harder to socially distance. Residents in buildings with 10 or more housing units may also have to touch potentially infected surfaces, like mailboxes and doors, shared with many neighbors.

  • #50. Vermont

    - Overall CCVI score: 0.02
    - #1 biggest area of vulnerability: Housing type & transportation (score: 0.76)
    --- 19,566 housing structures with 10+ units (5.9%)
    --- 17,260 households with no vehicle available (6.6% of all households)
    - #2 biggest area of vulnerability: Household composition & disability (score: 0.38)
    --- 113,550 over age 65 (18.2% of population)
    --- 88,944 disabled over age 5 (14.4% of population)

    In Vermont, rural areas have a larger population of older people than more urban counties, and these towns have less primary care doctors—a barrier for symptomatic people as primary care referrals are needed for testing. These areas are also further from major hospitals, an obstacle to receiving necessary care. In Vermont’s urban areas, several outbreaks have been linked to long-term care facilities.

  • #49. Maine

    - Overall CCVI score: 0.04
    - #1 biggest area of vulnerability (tie): Household composition & disability (score: 0.72)
    --- 259,176 over age 65 (19.4% of population)
    --- 209,438 disabled over age 5 (15.9% of population)
    - #1 biggest area of vulnerability (tie): Housing type & transportation (score: 0.72)
    --- 36,020 housing structures with 10+ units (4.9%)
    --- 40,732 households with no vehicle available (7.3% of all households)

    By the end of April, adults over 60 accounted for 44% of COVID-19 cases in the state, according to Maine’s Division of Disease Surveillance; more than half of the state’s 51 recorded COVID-19 deaths at that time were individuals in nursing homes with outbreaks. Elderly people in nursing homes may be at greater risk of catching the coronavirus given that residents live in close quarters. Once they catch the virus, they’re at greater risk of more severe disease as older people tend to have less effective immune systems.

  • #48. North Dakota

    - Overall CCVI score: 0.06
    - #1 biggest area of vulnerability: Housing type & transportation (score: 0.94)
    --- 73,282 housing structures with 10+ units (19.9%)
    --- 15,942 households with no vehicle available (5.1% of all households)
    - #2 biggest area of vulnerability: Healthcare system factors (score: 0.46)
    --- 2,003 hospital beds
    --- $3,817 healthcare spending per capita

    Crowded housing structures might put some North Dakota residents at greater risk of contracting COVID-19, and those who lack a vehicle may be at higher risk of exposure if they rely on public transit. While North Dakota was also ranked vulnerable in terms of its hospital beds, the state has set up eight field hospitals that could support an additional 4,000 beds if needed.

  • #47. Wisconsin

    - Overall CCVI score: 0.08
    - #1 biggest area of vulnerability: Housing type & transportation (score: 0.44)
    --- 284,323 housing structures with 10+ units (10.6%)
    --- 158,139 households with no vehicle available (6.7% of all households)
    - #2 biggest area of vulnerability: Healthcare system factors (score: 0.36)
    --- 11,050 hospital beds
    --- $29,722 healthcare spending per capita

    Peaks in Medicaid enrollment have historically occurred during recessions, a trend projected to continue across the U.S. in 2020. In Wisconsin, health officials have warned that the state needs to prepare for a surge in Medicaid enrollment that will exceed the state’s budget.

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  • #46. Colorado

    - Overall CCVI score: 0.10
    - #1 biggest area of vulnerability: Minority status & language (score: 0.62)
    --- 875,557 non-white (15.8% of population)
    --- 60,209 households with limited English (2.8% of all households)
    - #2 biggest area of vulnerability: Healthcare system factors (score: 0.52)
    --- 8,243 hospital beds
    --- $20,581 healthcare spending per capita

    In mid-April, the Colorado Department of Public Health and Environment (CDPHE) reported that minorities make up a disproportionate amount of COVID-19 cases: Latino people account for 22% of the state’s population but at the time accounted for about 28% of cases, while Black people make up 4% of the population but represented 7% of cases. Jill Hunsaker-Ryan, executive director of the CDPHE, told Jim Hill and Andrew Kenney of Colorado Public Radio: “There have been generations of institutionalized barriers to things like preventive medical care, healthy food, safe and stable housing, quality education, reliable transportation, and clean air. Research shows that these types of factors are the most predictive of health outcomes.”

  • #45. Minnesota

    - Overall CCVI score: 0.12
    - #1 biggest area of vulnerability: Healthcare system factors (score: 0.68)
    --- 10,518 hospital beds
    --- $28,265 healthcare spending per capita
    - #2 biggest area of vulnerability: Housing type & transportation (score: 0.64)
    --- 379,173 housing structures with 10+ units (15.7%)
    --- 148,982 households with no vehicle available (6.9% of all households)

    Hospitals all over the U.S. have canceled appointments and elective surgeries—important revenue sources—to reduce spread and make room for COVID-19 patients. To address these cost issues and prepare for a surge of cases, beginning in March, Minnesota health care systems reduced employee hours to save costs, including hours of nurses. Other hospitals laid off hundreds of staff members.

  • #44. California

    - Overall CCVI score: 0.14
    - #1 biggest area of vulnerability: Minority status & language (score: 1.00)
    --- 15.6 million non-white (39.9% of population)
    --- 1.2 million households with limited English (9.1% of all households)
    - #2 biggest area of vulnerability: Housing type & transportation (score: 0.86)
    --- 2.4 million housing structures with 10+ units (17.2%)
    --- 939,034 households with no vehicle available (7.2% of all households)

    While California ranks low for its overall CCVI score, it ranks highest out of all the states on the minority status & language vulnerability. Black and Latino Californians are dying more frequently of COVID-19, comprising a disproportionate share of deaths compared to white or Asian individuals. This is attributed to higher rates of underlying health conditions—like heart disease, obesity, diabetes, and asthma—as well as overcrowded housing conditions and “testing deserts.”

  • #43. Wyoming

    - Overall CCVI score: 0.16
    - #1 biggest area of vulnerability: Housing type & transportation (score: 0.80)
    --- 15,939 housing structures with 10+ units (5.8%)
    --- 8,873 households with no vehicle available (3.8% of all households)
    - #2 biggest area of vulnerability: Household composition & disability (score: 0.58)
    --- 87,777 over age 65 (15.1% of population)
    --- 74,118 disabled over age 5 (13.0% of population)

    Wyoming has low case and death counts relative to other states (the Wyoming Infectious Disease Epidemiology Unit reported about 480 confirmed cases and seven deaths as of May 7), which has prompted the state to allow certain businesses to reopen May 1. Teton County, which has one of the highest case counts in Wyoming, is following a different reopening timeline, acting with more caution to prevent further coronavirus spread.

  • #42. Utah

    - Overall CCVI score: 0.18
    - #1 biggest area of vulnerability: Healthcare system factors (score: 0.82)
    --- 4,630 hospital beds
    --- $9,440 healthcare spending per capita
    - #2 biggest area of vulnerability: Minority status & language (score: 0.48)
    --- 413,294 non-white (13.6% of population)
    --- 22,404 households with limited English (2.3% of all households)

    A Centers for Medicare and Medicaid Services analysis of state health care data found that states with relatively low health care spending per capita tend to have higher rates of uninsurance. While data from the Kaiser Family Foundation shows that Utah’s rate of uninsurance, 9%, is the same as the national average, the rate of uninsurance among Hispanic and Native American people is more than double that figure.

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