Effect of Neighborhood-Level Social Vulnerability on COVID-19 Hospitalizations

Researchers conducted a study to determine whether neighborhood-level social vulnerability is associated with an increased risk for hospitalization due to severe COVID-19 infection.

Although the risk for severe disease and hospitalization due to COVID-19 infection was found to be increased among patients from socially vulnerable neighborhoods, no differences in hospital mortality or discharge disposition were observed after hospital admission. These findings were published in Annals of Internal Medicine.

Researchers prospectively collected data from 38 hospitals in Michigan between March and December 2020. The researchers sought to determine if there is an association between hospitalizations due to severe COVID-19 infection and neighborhood-level social vulnerability, regardless of patients’ preexisting conditions. Neighborhood-level social vulnerability was determined via patients’ ZIP codes and social vulnerability index (SVI) scores (range, 0-1). A pooled cross-sectional study was conducted and a total of 2309 patients older than 18 years who were hospitalized with severe COVID-19 infection were enrolled. Patients excluded from the study included those who were pregnant, required transfer to hospice care within 3 hours of hospital admission, and those who were hospitalized for more than 120 days. The SVI scores were a composite measure of socioeconomic status, household composition and disability, racial/ethnic minority status, and type of housing and transportation. The primary outcomes were acute organ dysfunction, organ failure, invasive mechanical ventilation (IMV), transfer to an intensive care unit (ICU), in-hospital death, and hospital discharge.

The researchers assessed ZIP codes among all patients included in the analysis and found that 607 were from a neighborhood with high SVI score and 1702 were from a neighborhood with a low SVI score. Of these patients, the median ages were 63.5 (IQR, 49.8-73.0) and 65.6 (IQR, 53.9-77.7) years, 53.2% and 52.5% were men, 71.7% and 30.7% were Black, and median Charlson comorbidity scores were 2.0 and 1.0, respectively.

The researchers found that patients from a neighborhood with a high SVI score were more likely to be younger, Black or Hispanic, have comorbid conditions, and be insured by Medicaid compared with those from a neighborhood with a low SVI score. Additional comparisons between patients with high vs low SVI scores showed that those with high SVI scores were more likely to have abnormal findings in regard to oxygen saturation (≤ 80%; 5.4% vs 3.5%) but similar respiratory rates (≥ 20/min; 58.8% vs 59.5%). The rates of IMV (19.3% vs 14.2%), ICU transfer (29.0% vs 24.5%), acute organ dysfunction (51.9% vs 48.6%), hospital discharge (62.1% vs 60.1%), and in-hospital death (19.4% vs 16.7%) were increased among patients in the high SVI group vs those in the low SVI group.

This study was limited by its observational design, use of data on COVID-19 hospitalizations from only 1 US state, and potential discrepancies on patients’ charts.  

The researchers noted that “[their] findings shed important light on the various contributors to racial and ethnic disparities in outcomes after COVID-19 hospitalization.” Continuing, they urged policymakers to “target more socially vulnerable neighborhoods to improve access to COVID-19 testing, treatment, and vaccination, as well as to identify and address social needs to ameliorate disparities in COVID-19 health outcomes.”


Tipirneni R, Karmakar M, O’Malley M, Prescott HC, Chopra V. Contribution of individual- and neighborhood-level social, demographic, and health Factors to COVID-19 hospitalization outcomes. Ann Intern Med. Published online February 22, 2022. doi:10.7326/M21-2615