The Impact of Rurality, Underlying Cardiovascular Disease, and Socioeconomic Vulnerability on COVID-19 Outcomes in Georgia

Background: COVID-19 related illnesses have been associated with an increased prevalence of cardiovascular disease sequelae and worsened socioeconomic variables. We sought to investigate the relationship between COVID-19 outcomes, underlying cardiovascular disease, and socioeconomic determinants of health in rural and non-rural counties in the state of Georgia. Methods: COVID-19, demographic, and socioeconomic data were acquired from publicly available databases including the Centers for Disease Control and Prevention’s Social Vulnerability Index. The relationship between COVID-19 outcomes and markers of cardiovascular disease burden, rurality, and socioeconomic determinants of health was assessed at the county level in Georgia through the beginning of August 2020 using univariable and multivariable Poisson regression modeling. Results: In adjusted models, the risk of COVID-19 incidence was significantly higher in residents of non-rural Georgia counties while we observed no significant difference in COVID-19 case-fatality rates between residents of rural and non-rural Georgia counties. A significant adverse association between risk of COVID-19 cumulative case-fatality rates and recent mortality rates of stroke was detected, while counties with historically higher coronary heart disease death rates demonstrated significantly lower risk ratio of COVID-19 cumulative case-fatality rates. Additionally, Georgia counties with worsened indices of social and economic vulnerability demonstrated significantly higher risk ratio of COVID-19 incidence and case-fatality rates. Conclusions: In Georgia, COVID-19 incidence is adversely associated with non-rural county status, while both incidence and case-fatality rates are associated with historical indices of cardiovascular disease outcomes and higher social vulnerability. Efforts to mitigate COVID-19 spread and improve COVID-19 outcomes in Georgia may require additional focus on these most vulnerable areas.