Kobina Hagan MBBS, MPH Postdoctoral Fellow Center for Outcomes Research, Houston Methodist Research Institute

COVID-19: Mitigation Measures Correlate With Social Risk Profile

MedicalResearch.com Interview with:

Kobina Hagan MBBS, MPH Postdoctoral Fellow Center for Outcomes Research, Houston Methodist Research Institute

Dr. Hagan

Kobina Hagan MBBS, MPH Postdoctoral Fellow
Center for Outcomes Research,
Houston Methodist Research Institute

MedicalResearch.com: What is the background for this study?

Response: Before the COVID-19 vaccination roll-out, risk mitigation guidelines including respiratory hygiene, social distancing, and job flexibility, were the most effective preventive measures against coronavirus transmission. Social determinants of health scholarships had identified social circumstances to limit adherence to these mitigation guidelines. Individuals with underlying cardiovascular disease are identified as high-risk phenotypes for severe COVID-19 outcomes. In addition, research efforts during the early and middle waves of the pandemic had identified coronavirus exposure risk as a greater mediator of the observed COVID-19 disparities, compared to clinical susceptibility from comorbidities. Yet, population-based evidence on the practice of these mitigation guidelines in this high-risk group were lacking. Consequently, we believed there was a need to robustly characterize COVID-19 risk mitigation practices among adults with cardiovascular disease in the nation.

The COVID-19 Household Impact Survey was a survey conducted by the National Opinion Research Center at the University of Chicago, to provide statistics about health, economic security, and social dynamics of the US adult household population nationwide and for 18 geographic areas (10 states, 8 metropolitan statistical areas) between April and June 2020. This survey complemented the Household Pulse Survey by the Census Bureau.

In this study we described the COVID-19 risk mitigation practices among patients with CVD and evaluated the association between cumulative social determinants of health burden (a measure of social adversity) and adherence these measures. 

MedicalResearch.com: What are the main findings?

Response: In this study, we quantified an individual’s social adversity with a cumulative index comprising factors under economic stability, neighborhood/physical environment, education, food security, community/social context, and health care system. We grouped mitigation measures under three broad strategies: personal protection (masking, hand hygiene, physical distancing); social distancing (avoiding crowds, public places, and high risk contact); work flexibility (working from home, canceling/postponing work schedules when necessary).

Proportions of individuals who reported practicing measures under personal protection ranged between 89-95%, and 66-79% for social distancing measures. Opportunities for flexible work schedules were generally lower (less than 40% reported any flexible work schedule). We also observed the racial/ethnic differences in opportunities to work from home, as observed in the general population from previous studies. 40% of non-Hispanic Asians with CVD could afford to work from home during the pandemic, compared to only 9% of Hispanics and 13% of non-Hispanic Blacks with CVD with such opportunity.

Overall, the proportion of individuals practicing the mitigation measures decreased with worsening social risk profile. Fewer individuals with the worst SDOH profile compared to those with the most favorable profile reported practicing all personal protective measures (76% vs 89%), all social distancing measures (42% vs 59%), and affording at least one flexible work schedule (26% vs 41%). These trends persisted even after accounting for age, sex, race/ethnicity, comorbidity, and the period of the interview. 

MedicalResearch.com: What should readers take away from your report?

Response: The adherence to COVID-19 risk mitigation measures in medically vulnerable populations like those with cardiovascular disease decreased with poor social risk profile. This study lent further evidence to social determinants of health as key drivers of COVID-19. There is a need for health systems and health administrations to robustly identify individuals whose medical vulnerability is compounded by social adversity for targeted culturally competent health messaging. Further, we believe that COVID-19 vaccination coverage will face similar limitations by social circumstances which can be dire considering that vaccine demand outstrips supply globally.

MedicalResearch.com: What recommendations do you have for future research as a result of this work? 

Response: We recommend that research efforts be directed at developing and validating multidimensional tools for social risk profile which could be integrated into delivery of care to at-risk populations. The adoption of such tools in clinical care will better equip health systems to anticipate disproportionate needs for social support during pandemics and other public health emergencies.

Any disclosures?

Dr. Khurram Nasir, the corresponding author of the study, is on the advisory board of Amgen, Novartis, Medicine Company, and his research is partly supported by the Jerold B. Katz Academy of Translational Research.

No other conflicts of interest relevant to the content of this manuscript were reported by the authors. 


ACC 21 abstract

Social Determinants of Health Disparities for COVID-19 Mitigation Measures Among Adults with Cardiovascular Disease in the United States
Hagan KK, Javed Z, Cainzos-Achirica M, et al. Social determinants of adherence to COVID-19 risk mitigation measures among adults with cardiovascular disease. Circ Cardiovasc Qual Outcomes. 2021;Epub ahead of print.



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Last Updated on May 12, 2021 by Marie Benz MD FAAD