Who is “vulnerable?” It’s complicated!

According to the CDC, people with serious chronic conditions are at higher risk for severe illness from COVID-19.  Dr. Georgina Peacock, MD, Director, Division of Human Development and Disability, stated that some people are at risk for serious complications from COVID-19.  Vulnerable people are identified as:

• ·       Age 65 and over
• ·       Long-term care residents in nursing homes or assisted living facilities.  [Note: Only 5% of older adults reside in nursing homes. Not all residents are old. Approximately 15% of residents in nursing homes are below age sixty-five (Howley, 2019.)]
• ·       People with chronic conditions, especially those that remain uncontrolled or untreated:

o   Chronic lung disease

o   Asthma

o   Serious heart condition

o   Compromised immune system [Cancer treatment, smokers, transplant treatments, HIV/AIDS, or prolonged use of steroids]

o   Obesity, with BMI of 40+

o   Diabetes

o   Liver disease

o   Chronic kidney disease/dialysis

To protect yourself, the CDC recommends these four proactive approaches:

1. ·       Stay home
2. ·       Wash hands frequently
3. ·       Avoid close contact
4. ·       Clean and disinfect

The pandemic has not only changed our lives but the definition of “vulnerable.” With COVID-19, we have been confronted with an expanded definition that includes social factors.  While the risk factors above are valid and certainly indicate those at-risk medically, the editor of The Lancet medical journal suggests that socioeconomic and geographic factors also place people at risk and they are related directly to the COVID-19 pandemic (Editorial, 2020). Health inequalities are at the apex of the expanded definition.  Not everyone has the luxury of frequent hand washing, social distancing, or stocking up on supplies. Identified risk factors include people residing in dense populations, living at or below the poverty line, struggling mentally and physically with the crisis, social isolation, lack of transportation, homelessness, and undernourished (Editorial, 2020).  

I wanted to know more. As a gerontologist, I am aware of the negative impact of “food deserts” on aging. Without grocery stores nearby, residents buy groceries at dollar stores and mini-marts. With those businesses closed, it places thousands of citizens at risk due to poverty and geography, especially older adults.

Every day, the news sources present maps to help us understand and make sense of the pandemic facts and figures.  So many maps, so little time! Where are the least healthy people in America? What regions are at the highest risk?  How are poverty and vulnerability linked to risk? To seek answers, I found an interactive map from the Institute for Health Metrics and Evaluation (IHME, 2016).  I was not seeking a map.  The map was presented to me to help explain the pandemic.  I assume that maps are developed as user-friendly visual representation of facts.  Be careful using maps for interpretation, as they can be misleading. In seeking answers, I found no maps identifying The Lancet vulnerability factors, as those social factors cannot be mapped. However, I persisted.

The IHME map is divided into counties and identifies mortality, cancers, causes of death, life expectancy, smoking, obesity, physical activity, alcohol use, hypertension, and diabetes. The expanded risk factors identified in The Lancet (Editorial, 2020) are typically prevalent in the interactive IHME map. Health disparities are particularly evident when comparing the IHME map and the U.S. Census counties by the highest and lowest income. The Native American tribal populations in South Dakota and North Dakota stand out as bright red, the least healthy. The coal-mining areas of Kentucky and West Virginia glow orange.  Walker County, Alabama, is mostly blue-collar, agricultural workers, coal miners, and with high rates of smoking, obesity, and COPD from exposure from toxic substances.  Unhealthy Walker County stands out, as it is only one county away from the healthiest Alabama citizens residing in Shelby County.  The wealthiest counties in America are Loudoun and Fairfax County in Virginia and Howard County in Maryland.  However, they are not the healthiest. 

Don’t get carried away and jump to conclusions with maps, as the devil is in the details.  For example, the Florida IHME map has one bright red area (IHME, 2016). Union County, Florida’s population is 15,237 (U.S. Census Quick Facts, 2020). One-third of the Union County population is imprisoned, contributing to the high Union County poor health quality statistics. The abnormally high mortality rates in Union County may be driven by the large prison hospital at the prison Reception and Medical Center, providing advanced medical care and cancer specialization treatment.  The large population of sick prisoners is why that map area shows bright red!  Another example is Sumter County, Florida, an area with the oldest population in America.  It makes sense that the county with the oldest population would be bright red, as old people die more frequently than younger people. However, the IHME map identifies Sumter County as one of the healthiest in Florida! (IHME, 2016). 

Being over the age of 65 does not necessarily mean “vulnerable.”  Look further into the details, embrace the expanded definition from The Lancet journal, and critically seek answers. You will need more than a map. 

Be safe! Stay home! Wash hands! Social distance!  Agedoc

References:

Editorial: Redefining vulnerability in the era of COVID-19. [Editorial]. (2020, 4 April). The Lancet, 395, (10230). doi: https://doi.org/10.1016/S0140-6736(20)30757-1

Howley, E.K. (2019, October 11). Nursing home facts and statistics. Retrieved from U.S. News and World Report website: https://health.usnews.com/health-news/best-nursing-homes/articles/nursing-home-facts-and-statistics

Institute for Health Metrics and Evaluation (IHME). US Health Map. Seattle, WA: IHME, University of Washington, 2016. Retrieved from http://vizhub.healthdata.org/subnational/usa.  

U.S. Census Quick Facts. Union County, Florida (2020). Retrieved from https://www.census.gov/quickfacts/fact/table/unioncountyflorida,US/PST045219

U.S. Department of Health and Human Services, Centers for Disease Control (2020). Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-at-higher-risk.html