County-Level Sociodemographic Characteristics and Availability of COVID-19 Therapeutic Drugs

This cross-sectional study examines access to COVID-19 treatments in US counties by race and ethnicity, poverty rate, uninsured rate, and other population and community characteristics.


Introduction
There continues to be a weekly mean of 14 500 COVID-19 cases and 250 deaths in the US, necessitating ongoing administration of therapeutic drugs. 1 Research is limited on geospatial availability of COVID-19 treatments associated with local sociodemographic characteristics. 2 Understanding treatment availability is critical; therefore, we investigated geospatial patterns of COVID-19 therapeutic drugs to assess possible sociodemographic-based disparities across US counties.

Methods
Data on courses of COVID-19 therapeutic drugs available at different US health care sites on May 15, 2023, were obtained from the COVID-19 Public Therapeutic Locator. 3 In accordance with the Common Rule, this cross-sectional study was exempt from review and informed consent because it used public data.We followed the STROBE reporting guideline.
Crude rate was expressed as the total number of COVID-19 therapeutic drug courses in each county and was standardized by dividing the number of courses by the total population of each county and multiplying by 100 000 population (eMethods in Supplement 1).We used global Moran I to assess unusually concentrated counties with high and low levels of treatments, which provided z scores with P values (eMethods in Supplement 1). 4,5Anselin 4 local Moran I was then used to identify clusters of counties with available drugs that were different from neighboring counties.This analysis provided cluster types, including high-high clusters (counties with higher availability), low-low clusters (counties with lower availability), high-low and low-high outliers (counties with either high or low levels of availability surrounded by counties with either low or high levels of availability), and unclustered (counties with neither high nor low levels of availability).
Unpaired, 2-tailed t tests were used to compare sociodemographic characteristics (eg, selfidentified race and ethnicity; poverty) inside and outside of clustered counties.Two-sided P < .05indicated statistical significance.Analysis was performed with SAS 9.4 (SAS Institute Inc).

Results
A total of 95 294 courses of COVID-19 therapeutic drugs were available, with a mean (SD) of 30.7    g The SVI consists of 16 social factors grouped into 4 themes and measures the relative social vulnerability of each county.The SVI ranges from 0 to 1, with a higher value indicating that a community is more vulnerable to external stressors such as humandriven or natural disasters or disease outbreaks.
h The CCVI identifies communities more vulnerable to COVID-19 using data from the SVI and the Centers for Disease Control and Prevention.The CCVI ranges from 0 to 1, with a higher value indicating that a community is more vulnerable to socioeconomic, environmental, and health care risks from the COVID-19 pandemic.

(
91.8), in 3108 US counties.COVID-19 treatments were highly available (39.08-854.70 per 100 000 people) in some parts of New England, Kansas, and across the US (Figure, A).The Moran I value (0.09) for the total therapeutic drugs and z score (17.82) indicated that spatial clustering occurred across counties (P < .001).The Anselin local Moran analysis (Figure, B) showed high-high clusters around Maine, western Kansas and Nebraska, and eastern Montana.Low-low clusters appeared across the South and Midwest regions and some parts of the Western region.High-high clusters vs unclustered counties had a lower percentage of Black population, COVID-19 crude rate, poverty rate, household income, Social Vulnerability Index (SVI), and COVID-19 + Supplemental content Author affiliations and article information are listed at the end of this article.Open Access.This is an open access article distributed under the terms of the CC-BY License.JAMA Network Open.2023;6(9):e2334763.doi:10.1001/jamanetworkopen.2023.34763(Reprinted) September 20, 2023 1/4

Figure .
Figure.Crude Rate of COVID-19 Therapeutic Drugs and Clustering of Therapeutic Drugs in US Counties Community Vulnerability Index (CCVI) (Table).Compared with unclustered counties, low-low clusters were more likely to have a higher percentage of Black population, poverty rate, uninsured rate, SVI, and CCVI and a lower percentage of Hispanic population and household income.High-low outliers were more likely than unclustered counties to have a higher percentage of Black population, COVID-19 crude rate, poverty rate, uninsured rate, SVI, and CCVI and a lower percentage of Hispanic population and household income.Low-high outlier clusters were more likely than unclustered Downloaded From: https://jamanetwork.com/ on 09/23/2023 counties to have a lower percentage of Black population, household income, and CCVI and a higher percentage of Hispanic population and uninsured rate.
Cluster types of counties: unclustered had neither high nor low levels of COVID-19 therapeutic drug availability; high-high clusters had high availability; low-low clusters had low availability; high-low outliers had high availability and were surrounded by counties with low availability; and low-high outliers had low availability and were surrounded by counties with high availability.
4Hot and cold spots clustering of therapeutic drugs in the US counties B Data (panel B) were based on Anselin4local Moran I values.Cluster types were high-high, indicating counties with high availability of COVID-19 therapeutic drugs; low-low, counties with low availability; high-low outlier, counties with high availability surrounded by counties with low availability; low-high outlier, counties with low availability surrounded by counties with high availability; and unclustered, counties with neither high nor low levels of availability.Outliers a b Race and ethnicity were self-identified.These data were obtained from the Agency for Toxic Substances and Disease Registry (https://www.atsdr.cdc.gov/placeandhealth/svi/ dta_documentation_download.html).We selected Black or African American and Hispanic or Latino groups for examination.c P < .001.Unpaired, 2-tailed t tests were used to compare values between unclustered and other cluster types.e P < .05. f P < .01.