Variations in COVID-19 impacts by social vulnerability in Philadelphia, June 2020-December 2022

Introduction The study objective was to elucidate the relationship between social vulnerability and COVID-19 impacts in Philadelphia over a 2.5-year period, between June 2020 and December 2022. Methods Using publicly available COVID-19 case, test, hospitalization, and mortality data for Philadelphia (June 7, 2020-December 31, 2022) and area-level social vulnerability data, we compared the incidence, test positivity, hospitalization, and mortality rates in high and low vulnerability neighborhoods of Philadelphia, characterized as scoring above or below the national median score on the social vulnerability index. We used linear mixed effects models to test the association between social vulnerability and COVID-19 incidence, test positivity, hospitalization, and mortality rates, adjusting for time and age distribution. Results 90.4% of Philadelphians ( n = 1,430,153) live in neighborhoods classified as socially vulnerable, based on scoring above the national median score on the social vulnerability index. COVID-19 incidence, hospitalization, and mortality rates were significantly elevated in the more vulnerable communities, with p < 0.05, p < 0.005, and p < 0.001, respectively. The relative risks of COVID-19-related incidence, hospitalization, and death, comparing the more vulnerable neighborhoods to the less vulnerable neighborhoods, were 1.11 (95%CI: 1.10-1.12), 2.07 (95%CI: 1.93-2.20), and 2.06 (95%CI: 1.78-2.38), respectively. Thus, between June 7, 2020 and December 31, 2022, 32,573 COVID-19 cases, 9,409 hospitalizations, and 1,967 deaths would have been avoided in Philadelphia’s more vulnerable communities had they experienced the same rates of incidence, hospitalization, and death as the less vulnerable Philadelphia communities. Conclusions These results highlight the disparate morbidity and mortality experienced by people living in more vulnerable neighborhoods in a large US city. Importantly, our findings illustrate the importance of designing public health policies and interventions with an equity-driven approach, with greater resources and more intensive prevention strategies applied in socially vulnerable communities. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study was funded by the Global Genomics and Health Equity Pilot Project RFA (GGHE-KP-2021-001). ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: All source data were openly available before the initiation of the study. The 2018 Social Vulnerability Index Data was downloaded from the ATSDR/CDC site ([https://www.atsdr.cdc.gov/placeandhealth/svi/data\_documentation\_download.html][1]). We also used data from the 2020 American Community Survey (ACT) Five Year Estimates (available for download here: ), and various COVID-19 data reported by the City of Philadelphia on the OpenDataPhilly website (). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes All data are available online. The 2018 Social Vulnerability Index Data was downloaded from the ATSDR/CDC site ([https://www.atsdr.cdc.gov/placeandhealth/svi/data\_documentation\_download.html][1]). We also used data from the 2020 American Community Survey (ACT) Five Year Estimates (available for download here: ), and various COVID-19 data reported by the City of Philadelphia on the OpenDataPhilly website (). [https://www.atsdr.cdc.gov/placeandhealth/svi/data\_documentation\_download.html][1] [1]: https://www.atsdr.cdc.gov/placeandhealth/svi/data_documentation_download.html