Where Chronic Health Conditions and Coronavirus Could Collide

As the new coronavirus continues to spread over the next months, and maybe even years, it could exact a heavy new toll in areas of the United States that have not yet seen major outbreaks but have high rates of diabetes, obesity, high blood pressure and other chronic health conditions.

Large parts of the South and Appalachia are especially vulnerable, according to a health-risk index created for The New York Times by PolicyMap, a company that analyzes local health data. The index for the first time identifies counties with high rates of the underlying conditions that increase residents’ risk of becoming severely ill if they are infected with the coronavirus.

Even in lower-risk counties, a significant proportion of the population is living with these conditions.

WASH.

Covid-19 health risk

MONT.

MAINE

N.D.

Lower

Higher

MINN.

ORE.

VT.

N.H.

WIS.

IDAHO

S.D.

N.Y.

MASS.

WYO.

MICH.

R.I.

CONN.

IOWA

PA.

NEB.

NEV.

N.J.

OHIO

ILL.

MD.

IND.

UTAH

DEL.

D.C.

COLO.

W.VA.

CALIF.

VA.

KAN.

West Virginia has not

yet seen a significant

outbreak, but it has

one of the most

medically vulnerable

populations.

MO.

KY.

N.C.

TENN.

OKLA.

ARIZ.

ARK.

N.M.

S.C.

Much of Colorado has a lower relative risk for severe Covid-19 illness, but more than 20 percent of the adult population is estimated to be obese.

ALA.

GA.

MISS.

LA.

TEXAS

FLA.

ALASKA

Alabama has a high

burden of chronic health

conditions. In many

counties, more than 40

percent of adults are

estimated to be obese.

HAWAII

Covid-19 health risk

Lower

Higher

3

1

2

West Virginia has not yet seen a significant outbreak, but

it has one of the most medically vulnerable populations.

1

Alabama has a high burden of chronic health conditions. In many counties, more than 40 percent of adults are estimated to be obese.

2

Much of Colorado has a lower relative risk for severe Covid-19 illness, but more than 20 percent of the adult population is estimated to be obese.

3

WASH.

Covid-19 health risk

MONT.

MAINE

N.D.

Lower

Higher

MINN.

ORE.

VT.

N.H.

WIS.

IDAHO

S.D.

N.Y.

MASS.

WYO.

MICH.

R.I.

CONN.

IOWA

PA.

NEB.

NEV.

N.J.

OHIO

ILL.

MD.

IND.

UTAH

DEL.

D.C.

COLO.

W.VA.

CALIF.

West Virginia

has not yet

seen a

significant

outbreak, but it

has one of the

most medically

vulnerable

populations.

VA.

KAN.

MO.

KY.

N.C.

TENN.

ARIZ.

OKLA.

ARK.

N.M.

S.C.

Much of Colorado has a lower

relative risk for severe Covid-19

illness, but more than 20

percent of the adult population

is estimated to be obese.

ALA.

GA.

MISS.

LA.

TEXAS

FLA.

ALASKA

Alabama has a high burden

of chronic health conditions.

In many counties, more than

40 percent of adults are

estimated to be obese.

HAWAII

Note: The health risk shown for a given county is compared with the national average.

Public health experts warn that these areas may not be adequately prepared for new waves of infection, even as some have lifted restrictions meant to curb the spread of the virus.

“Places that have not seen a lot of infection yet should be thinking about what infection is going to mean once they have an outbreak there,” said Micaela E. Martinez, a professor at Columbia University’s Mailman School of Public Health.

“This infection is highly contagious and we have no vaccine, so it will inevitably sweep through our populations unless we have very tight measures in place to prevent that from happening,” Dr. Martinez said. Once it does, the overall health of a community will matter, she added.

The map above shows where U.S residents are at increased risk for severe Covid-19 illness, compared with the national average. It is based on the estimated proportion of adults in each county who have one or more of these conditions: diabetes, high blood pressure, obesity, heart disease and chronic lung disease, using survey data from the Centers for Disease Control and Prevention.

A majority of patients hospitalized with Covid-19 in the New York City area, an early epicenter of the nation’s outbreak, had one or more underlying health conditions. Studies from the C.D.C. and others suggest that, once infected with the coronavirus, people with such conditions are at particular risk for severe illness, including hospitalization and death. The conditions do not on their own increase a person’s chance of catching the disease.

High-Risk Counties Where Coronavirus Cases Are Growing

Notes: The health risk shown for a given county is compared with the national average. The average daily growth rate of total coronavirus cases is for the seven-day period ending May 14, 2020. Counties with at least 20 total reported cases and positive growth rates are shown. A person may have more than one health condition.

The index does not include age as a separate risk factor, though several of these conditions are more common in older people. The new coronavirus has been particularly brutal for seniors, who are hospitalized and die at higher rates than younger people. But underlying health conditions appear to increase the risk of serious illness across age groups.

In all, more than half of Americans have at least one condition that increases their risk of becoming seriously ill if infected.

“It’s important to recognize that it’s not some ‘other people’ that are vulnerable,” said Caitlin M. Rivers, an assistant professor at Johns Hopkins Center for Health Security. “The kinds of conditions that put people at higher risk are extremely common.”

But while many people have these conditions, there are important disparities by age, race and income.

Heart disease and hypertension are more common among older people. Obesity rates are similar across age groups in America, but higher among black and Hispanic people than among white people.

Lower-income groups and communities of color face significant health disparities, including higher rates of chronic health conditions, as well as lower health insurance rates and more limited access to health care.

Such disparities reflect historical and current inequalities, said Nancy Krieger, a professor of social epidemiology at the Harvard T.H. Chan School of Public Health, including a long-term lack of resources and opportunity.

And these same groups may also be at higher risk for catching the virus. Black and Hispanic workers more frequently have jobs classified as critical or otherwise lack the ability to stay home, and they more often live in multigenerational and crowded homes where it is harder to isolate if infected with the coronavirus. “It’s a compounding of risk,” Dr. Krieger said.

In New York City, the impact of coronavirus — both in cases and deaths — has been disproportionately concentrated in lower-income neighborhoods and communities of color. Similar racial and socioeconomic inequalities have been seen in outbreaks across the country.

Identifying high-risk communities could help policymakers better anticipate future outbreaks.

“If you’re an official or city planner or hospital administrator, you want to know what to expect when the disease hits,” said Dr. Leora Horwitz, a co-author of a study that evaluated underlying conditions among coronavirus patients hospitalized in the NYU Langone Health System. Or, she added, if it hits again.

Dr. Krieger of Harvard said data on health risk should inform targeted interventions and public health messaging. “Can we pinpoint where more testing needs to be done or made accessible and affordable?” she said. “Where is the greatest need for community outreach, for contact tracing?”

In the end, keeping new coronavirus infection and death rates low for people at high health risk requires keeping them low over all, Dr. Horwitz said. “The more disease is in the community, the more disease among people at high risk, period.”

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