Chapter 1: COVID-19 and People With Disabilities: Social Inequalities in the Distribution of Pandemic Vulnerability

This chapter addresses the growing need to analyze the relationship between COVID-19 vulnerability and disability status at the national scale in the US. It presents a quantitative study that seeks to determine whether US counties more vulnerable to the COVID-19 pandemic contain significantly higher percentages of people with disabilities (PwDs), in general, and socially disadvantaged PwDs (based on their ethnicity/race, biological sex, age poverty, and employment status), in particular.

Vulnerability to COVID-19 is measured using the COVID-19 Pandemic Vulnerability Index (PVI) model developed by the National Institute of Environmental Health Sciences, which integrates multiple variables into relevant indicators that are weighted and combined to formulate a county-level PVI score. These scores are linked to a wide range of disability-related variables from the 2019 American Community Survey five-year estimates. Statistical analyses are based on multivariable generalized estimating equations that extend the generalized linear model to account for spatial clustering.

US counties more vulnerable to the COVID-19 pandemic are characterized by significantly higher percentages of PwDs, when vaccination is considered in estimating the PVI. These counties also contain significantly higher percentages of ethnic/racial minority, female, below poverty, and unemployed PwDs, in multiple timeframes of the pandemic.

The findings provide important insights and new knowledge on the relationship between COVID-19 vulnerability and socially disadvantaged PwDs in the US. The county-level associations highlight the need for additional data and more detailed analysis to examine the differential impacts of this pandemic on PwDs, as well as formulate appropriate intervention strategies.