Abstract

The study seeks to explore the impacts of social disadvantage on public health in
unprecedented times of the COVID-19 pandemic. We simultaneously capture multiple risk
factors mediating the COVID-19-related outcomes through the concept of a multi-dimensional
social disadvantage and map geographical inequalities in coronavirus disease 2019 morbidity
and mortality in Tennessee. Disadvantaged communities suffer a greater burden due to being
already vulnerable prior to the COVID-19 pandemic and may have higher numbers of confirmed
and probable cases and deaths in the community. It is important to identify “high-priority areas”
where resources including testing kits and facilities need to be provided in a timely fashion to
mitigate community spread. We identified counties in Tennessee with a greater burden of the
disease due to a concentration of contributing factors. These include exposure to air pollution,
obesity, minorities/Hispanic ethnicity, poverty, and crowded household conditions. The areas
with high shares of the above-listed risk factors have been designated as “high social
disadvantage”, while areas with low shares have been designated as “low social disadvantage”.
We tested the relationship between socio-economic deprivation and the burden from COVID-19-
related morbidity and mortality (the primary health outcomes) in Tennessee.