Inequalities in Accessing Healthcare in the United States of America: A Major Contributor to the Increasing COVID-19 Morbidity and Mortality

Document Type : Original Article


1 Department of Community Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria

2 Department of Community Medicine, University College Hospital, Ibadan, Oyo State, Nigeria

3 Rollins School of Public Health, Emory University, Atlanta, GA, USA



Introduction: Many COVID-19 cases and deaths have been reported from the United States (US). This study aimed to assess the health system inequalities as a determinant of COVID-19 case morbidity and mortality in the US.
Methods: This study collected data on US COVID-19 cases and deaths as of the 27th of January 2021 from the Worldometer and COVID-19 Community Vulnerability Index. The strength of association between the social vulnerability index (SVI), total COVID-19 deaths and tests, and regional population in the US were determined using Pearson’s correlation. P values < 0.05 were statistically significant.
Results: New York has the highest SVI (0.94) in the North-Eastern region and the highest percentage of non-Whites. California has the highest SVI (0.90) in the Western region and the highest proportion of Asians. In the mid-Western region of the US, Illinois has the highest SVI (0.88) and the highest proportion of African Americans and Asians. North Carolina has the highest SVI of (1.00) in the Southern region and the highest proportion of African Americans. A strong positive correlation exists between the SVI and total COVID-19 tests (P = 0.001) in the North-eastern and Southern regions (P = 0.025). In addition, a positive correlation (P < 0.039) exists between SVI and the total population in the Western and mid-Western regions (P < 0.003).
Conclusion: Multi-sectoral collaboration should be encouraged to promote equity in accessing COVID-19 healthcare in the US, especially in States with high COVID-19 SVI.