Cities With High Comorbidities Could See More Severe COVID-19 Cases
Patients who have certain underlying medical conditions, also referred to as comorbidities, are more at risk of developing serious illness from COVID-19. According to the Centers for Disease Control and Prevention (CDC), having the following conditions with COVID-19 can increase the risk for severe illness:
Chronic kidney disease
Chronic obstructive pulmonary disease (COPD)
A weakened immune system (immunocompromised state) from a solid organ transplant
Obesity (body mass index [BMI] of 30 or higher)
Serious heart conditions, such as heart failure, coronary artery disease, or cardiomyopathies
Sickle cell disease
Type 2 diabetes
We took a deeper look at geographic areas where these conditions may be occurring at higher rates than the national average. The following cities have the highest rates of comorbidities and may have populations more at risk for severe cases of COVID-19 and complications from the disease.
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Cities with the highest rates of comorbidities, by condition
To identify areas in the United States at higher risk of COVID-19 complications, we examined metropolitan statistical areas (MSAs) that had the highest hospitalization and prevalence rates for hypertension, diabetes, obesity, and coronary heart disease based on CDC data (prevalence is the proportion of people in a population with a given disease over a specified period of time). MSA is an area that contains a city and surrounding communities that are closely associated with that city due to social and economic ties.
We’ve highlighted the top 10 areas for each comorbidity where the rates are above the national average. Six MSAs made it on three of the comorbidities’ top 10 lists, and two MSAs hold the number one spot for all four of these comorbidities: Pine Bluff, Arkansas and Bay City, Michigan. The city of Pine Bluff has the highest prevalence of diabetes and obesity while Bay City has the highest hospitalizations for hypertension and coronary heart disease.
According to CDC data, Jefferson County, where Pine Bluff is located, has one of the highest numbers of COVID-19 cases in Arkansas. Likewise, Bay County, where Bay City is located, is experiencing the second-highest level of COVID-19 cases in Michigan.
Hypertension
Four MSAs in Michigan had the highest rate of hypertension hospitalizations. MSAs in Alabama, Arkansas, and Florida also have higher-than-average rates of hypertension hospitalizations.
Diabetes
Six of the 10 cities that have the highest rates of diabetes hospitalizations are in Alabama. Cities in Arkansas and Mississippi also have high rates.
Obesity
Four out of the top 10 cities for highest obesity prevalence are in Louisiana. Arkansas, Michigan, and Pennsylvania also have high rates of obesity.
Coronary heart disease
The top four cities with a high hospitalization rate of coronary heart disease are in Michigan.
Taking a look by state
We further examined the data to identify how many of the top cities for all four comorbidities were in each state. It turns out that these cities were located mainly in the Southeast and Midwest. The state with the highest number of cities with high comorbidities was Alabama.
Summing it all up
Patients who have comorbidities are more at risk of severe illness from COVID-19 infections. Since these cities have both high comorbidities and a high number of COVID-19 cases, health officials there should be prepared for potentially more high-risk patients with COVID-19 infections.
In addition, this information can be used to determine the best resource allocation during the pandemic. Complications due to COVID-19 can mean more hospitalizations, which require more healthcare resources (such as ventilators, personal protective equipment, and medications), more expenses, and higher risk of death. In areas where comorbidities are higher, the risk of complication will also be higher. Therefore, we should consider devoting more resources to these communities.
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Co-contributor: Diane Li
Methodology
We used the following CDC county-level hospitalization/prevalence data tables for our analyses:
Diagnosed Diabetes, Age-Adjusted Percentage, 20+, 2015
Obesity, Age-Adjusted Percentage, 20+. 2015
Coronary Heart Disease Hospitalization Rate per 1,000 Medicare Beneficiaries, 65+, All Races/Ethnicities, Both Genders, 2014-2016
Hypertension Hospitalization Rate per 1,000 Medicare Beneficiaries, 65+, All Races/Ethnicities, Both Genders, 2014-2016
The county-level CDC data was rolled up to the MSA level using the delineation files mentioned above and population information from the American Community Survey (ACS) 5-year estimates (2011-2016), specifically table B10001 and table C27006. Additionally, any CDC data presented as a rate per 1000 Medicare beneficiaries was transformed to a rate of all Medicare beneficiaries.
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