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U.S. communities with limited internet access reported higher COVID-19 death rates during the first year of the pandemic, according to a recent study published in JAMA Network Open.
Between 2.4 and six deaths per 100,000 people could have been prevented, the researchers estimated, depending on whether they were in rural, suburban or urban areas.
“More awareness is needed about the essential asset of technological access to reliable information, remote work, schooling opportunities, resource purchasing and/or social community,” the study authors wrote.
“Populations with limited internet access remain understudied and are often excluded in pandemic research,” they added.
The finding points to the inequitable internet access across the U.S., according to Vox, with gaps often associated with older adults, lower income and education, minorities and rural areas. Many of the country’s most marginalized communities have the fewest, most expensive and lowest-quality choices for internet service providers, which could reduce access to information and health care services such as telemedicine.
In the recent study, researchers from the University of Chicago analyzed mortality data from the Centers for Disease Control and Prevention for more than 3,100 counties between January 2020 and February 2021. They looked at the racial and spatial disparities in COVID-19 death rates, as well as social determinants of health such as location, socioeconomic status and mobility.
The research team identified counties with a high concentration of a single racial and ethnic population and a high level of COVID-19 deaths as “concentrated longitudinal-impact counties.” They found that different aspects of the social determinants of health were “uniquely associated” with higher COVID-19 death rates among Black or African American communities, Hispanic or Latinx communities and non-Hispanic white communities.
For instance, counties with high COVID-19 deaths in large Black or African American populations were spread across urban, suburban and rural areas and experienced several disadvantages, the study authors wrote, including higher income inequality and more preventable hospital stays.
Most counties with high COVID-19 death rates in large Hispanic or Latinx populations were in urban areas, and many had a high percentage of people without health insurance.
Counties with high COVID-19 death rates in non-Hispanic white populations tended to be in rural areas with limited access to health care and larger numbers of older adults.
The findings varied by location as well. In urban areas, high death rates were associated with a high percentage of working-age people without health insurance and essential workers who were more likely to be exposed to the coronavirus.
“This finding is consistent with previous findings in Latinx adults who were more often at risk for contracting COVID-19 because of work requirements and hesitant about going to a hospital because of economic and immigration concerns,” the study authors wrote.
In suburban areas, higher mortality was associated with lower socioeconomic status and limited mobility, which tends to indicate higher poverty rates and higher percentages of older adults and people with disabilities.
In rural areas, higher COVID-19 death rates were associated with more preventable hospital stays and limited mobility.
Limited internet access was a significant factor in all communities, the study authors wrote. In rural areas, a 1% decrease in a county’s internet access was associated with 2.4 deaths per 100,000 people. In urban areas, a decrease in access was associated with six deaths per 100,000 people.
“For future public health interventions and policy proposals, this analysis offers one way to apply a chisel rather than a hammer to identifying, prioritizing, and tackling social factors associated with deeply entrenched health inequities across racial and ethnic groups and spaces,” the study authors wrote.
JAMA Network Open: “Assessment of Structural Barriers and Racial Group Disparities of COVID-19 Mortality With Spatial Analysis.”
Vox: “The surprising link between Covid-19 deaths and … internet access.”
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