Charting COVID’s Impact on the Most Vulnerable

The power of data has been a critical element of the planning and response to the COVID-19 pandemic – from allocating PPE and pharmaceuticals to predicting surges to ensure sufficient hospital capacity.

For the New Jersey Hospital Association (NJHA), data has also been a vital tool to better understand how vulnerable New Jerseyans are placed at greater risk during an infectious disease outbreak. A series of data bulletins from NJHA’s Center for Health Analytics, Research and Transformation (CHART) has provided greater understanding of these public health challenges and knowledge to better protect vulnerable populations from future threats.

Black Patients Experience Highest COVID-19 Mortality Rates

CHART’s bulletin from May 2020 was one of the first reports to quantify the racial and ethnic disparities in COVID incidence and mortality. The analysis, based on hospital discharge data, showed that Asian and Hispanic individuals had higher age-adjusted diagnosis rates, while black patients have the highest age-adjusted mortality rate.

Age-adjusted diagnosis rates by race/ethnicity and gender showed:

Asians had the highest age-adjusted diagnosis rate, at 25.7 per hundred population for males and 21.3 per hundred population for females.

Hispanics had the second-highest age-adjusted diagnosis rate, at 20.3 per hundred population for males and 17.6 per hundred for females.

The most impacted communities differ when examining those with the highest age-adjusted COVID-19 mortality rate. The analysis showed:

Black New Jerseyans had the highest COVID-19 age-adjusted mortality rate of 8.4 per hundred population for males and 7.4 per hundred population for females

White patients followed, with a 7.9 per hundred population mortality rate for males and 5.7 per hundred population for females.

Hispanics had the third highest COVID-19 mortality rate, at 7.8 per hundred population for males and 5 per hundred population for women.

In addition to the differences based on race and ethnicity, CHART’s analysis revealed disparities based on gender. Males, with the exception of the black population, were diagnosed with COVID-19 at a higher rate than females. However, black males had a significantly higher mortality rate than black females.

These early findings raised questions about social determinants of health and patient outcomes in the pandemic. Data from Healthy People 2020 shows that black communities experience higher poverty rates and higher uninsured rates. Housing, employment, food access, transportation and education are other social concerns with tremendous impacts on health. Those impacts influence health status. For example, the hypertension rate for black New Jerseyans is 40.9%, compared with 31.3% in Hispanics, 28.55% for white residents and 23.8% for Asian residents. Black New Jerseyans also have the state’s highest rates of diabetes and obesity, according to the N.J. State Health Assessment Data. Those are among the most common co-morbid conditions cited in COVID-19 deaths.

This report in the early months of the pandemic launched discussions on the importance of safe spaces for quarantine, high-density living conditions and child and family resources for vulnerable groups.

The Other Epidemic: The Mental Health Toll of COVID

By April 2021, NJHA’s data analysis documented that the prevalence of anxiety, depression and drug and substance abuse had all increased among New Jersey residents amid the pandemic. The CHART bulletin, The Other Epidemic: The Mental Health Toll of COVID-19, revealed that the mental health challenges were particularly pronounced in young people.

NJHA analyzed claims data from New Jersey hospital emergency departments along with survey responses from New Jersey residents who participated in the U.S. Census Bureau’s Household Pulse Survey. The two sources helped quantify the impact of the mental strain of COVID-19 on the state’s residents. Key findings showed:

42% of NJ adults who responded to the Census Bureau’s Household Pulse Survey between Jan. 20 and Feb. 1, 2021, reported having anxiety or depression symptoms, compared with 40% nationally.

The prevalence of an anxiety or depressive disorder was highest among young adults ages 18 to 29 years, with 58.6% reporting that they have experienced such symptoms during the pandemic.

The survey data also showed the impact of job loss on mental health. Half of NJ residents who reported losing their job in the pandemic said they experienced anxiety or depression symptoms, compared with 34.2% who did not experience job loss.

NJ hospital data, gathered through emergency department claims, showed similar impacts – again, with children and young people experiencing some of the greatest impact. From April through December 2020, the proportion of those under 18 years presenting with a primary or secondary diagnosis for depressive disorders increased by approximately 84% compared to the same period in 2019 (1.37% to 2.53%), while anxiety among this age group increased more than 74% (1.22% to 2.12%). In addition, anxiety diagnoses increased by roughly 15% among 18- to 29-year-olds (5.3% to 6.1%), and “other” mental and behavioral health diagnoses jumped by 23% in this age group (4.3% to 5.3%).

The ED claims data also showed a pronounced increase in drug and substance abuse diagnoses. For all age groups combined, the proportion of drug/substance use diagnoses increased approximately 29% from 2019 to 2020, from 5.2% to 6.8%.

While the overall percentage was small, the proportion of drug/substance abuse diagnoses for children and adolescents, ages 17 years and under, jumped from 0.56% in 2019 to 1.07% in 2020 – a 91% increase.

NJ’s Most Vulnerable Zip Codes Hit Hardest by COVID

Preparing for the next big public health threat could be more effective by focusing on communities that are lacking in social determinants of health.

The New Jersey Vulnerable Communities Database, developed in 2019 by NJHA, showed that many of the zip codes hit hardest by COVID were the very same as those identified before the pandemic by NJHA’s vulnerable communities algorithm. All told, seven of the original 10 most vulnerable zip codes experienced the highest per capita rate of COVID-19 cases in the pandemic. Those zip codes are in Camden (with four of the most highly impacted zip codes), Trenton, Newark and Paterson.

The database, available at www.njha.com/vulnerable-communities, contains data on 20 health indicators including chronic conditions, lack of prenatal care and premature death, along with social measures such as food access, high school graduation rates and employment status. The scorecard aggregates the findings and then indexes the results across New Jersey’s 537 zip codes.

When first introduced in 2019, the database utilized 2018 data. The 2021 update is based on 2019 data and shows the same zip codes remained in the top 10 most vulnerable. In the 2021 update, zip code 08104 in Camden ranked as the most vulnerable in the state, followed by: 08103 Camden, 08608 Trenton, 08102 Camden, 07102 Newark, 08401 Atlantic City, 07505 Paterson, 08105 Camden and 07114 Newark.

“If you overlay a map of the most vulnerable zip codes identified by this data, they are very much aligned with the areas that suffered the highest toll of illness during COVID,” NJHA President and CEO Cathy Bennett says. “This data reinforces a critical lesson: When it comes to population health, the health of the entire state is inextricably linked to the health of our most vulnerable.” 

These and other data resources from NJHA’s Center for Health Analytics, Research and Transformation can be found at www.njha.com/CHART.