SDOH Plays Key Role in COVID-19 Community Metrics, Aetna Foundation Report Finds

A new report from U.S. News & World Report and the Aetna Foundation—the philanthropic affiliate of CVS Health—reveals that counties that perform better in the 2020 Healthiest Communities rankings tend to have a lower COVID-19 case rate.

This year, the rankings are accompanied by new tools tracking COVID-19 data, as well as in-depth analysis on relationships between COVID-19 and the social determinants of health (SDOH) in populations at the local level, especially in underserved communities across America.

One key finding was that the top 500 healthiest communities have a COVID-19 case rate that is 40 percent lower than other counties (889 cases per 100,000 people, compared with 1,493 per 100,000). For the top overall healthiest community—Los Alamos, New Mexico—the rate of 124 cases per 100,000 residents is one of the 100 lowest rates in the country.

According to U.S. News & World Report, the Healthiest Communities rankings  show how nearly 3,000 U.S. counties and county equivalents perform in 84 metrics across 10 health and health-related categories.

The broad framework of categories and subcategories is based on factors key to evaluating community health that were identified by the National Committee on Vital and Health Statistics – a policy advisory board to the head of the U.S. Department of Health and Human Services (HHS) – as part of its Measurement Framework for Community Health and Well-Being. U.S. News adapted the NCVHS model in consultation with leading population health experts, resulting most notably in the inclusion of an equity category.

To determine the weights assigned to each category, more than a dozen experts in population health and well-being participated in an online survey in which they assessed each category's relative importance to community health. Each individual distributed 100 points across the 10 health and health-related categories, assigning more points to categories they perceived to be more important. The total points assigned to each category were then averaged to create final category weights, officials explained.

The Healthiest Communities rankings, underwritten by the Aetna Foundation, are part of a $100 million commitment by CVS Health and its affiliates. Other key data points from this year’s rankings, which included a specific focus on COVID-19, include:

• Within the Healthiest Communities rankings, case rate is most strongly linked to scores in the Community Vitality category, a measurement that includes voting and census participation. In counties where more than two-thirds of households participated in recent iterations of the Census Bureau’s American Community Survey, coronavirus case rates were less than half of what they were in counties where a smaller share of households participated.
  
• COVID-19 death rate is most strongly linked to community scores in the Equity category, particularly to measures of income equality, a link that indicates the racial disparities the novel coronavirus has exposed.
  
• Counties that have an above-average share of Black residents (about 13 percent or more) have an average COVID-19 case rate that is 1.4 times the national average and an average COVID-19 death rate that is 1.2 times the national average. Counties that are majority-Black (more than 50 percent) have an average case rate and death rate that are about double the national average.
  
• Counties that have an above-average share of Hispanic residents (about 18 percent or more) have a COVID-19 case rate that is about 14 percent higher than the national average. Counties that are majority-Hispanic (more than 50 percent) have an average COVID-19 case rate that is 1.4 times the national average and a COVID-19 death rate that is also higher than the national average.

“The COVID-19 pandemic has brought attention to the existing disparities in our healthcare system that have a significant impact on underserved communities,” said Garth Graham, vice president of community health and chief community health officer, CVS Health. “Using data from the Healthiest Communities rankings can help create insight on how to better address COVID-19 at the community level, while also helping health care organizations develop solutions to combat the health inequities that have plagued our underserved communities for many years.”