States of Emergency: Coronavirus is a disaster in the southern US due to obesity and diabetes
Not all states are created equally when it comes to health. Year after year, most of the Southern states — that seceded during the Civil War — have consistently ranked among the worst in the US in health. Many have a high prevalence of obesity, a high prevalence of cardiovascular disease and death rate, as well as high diabetes rate. These factors make them particularly vulnerable to COVID-19, which poses a greater risk for people with underlying health conditions.
The 11 southern states are South Carolina, Mississippi, Florida, Alabama, Georgia, Louisiana, Texas, Virginia, Arkansas, North Carolina, and Tennessee.
“For decades, people in the 11 states that seceded during the Civil War — America’s poorest region — have suffered from a scourge of obesity and hypertension, which intensify the danger of the (novel) coronavirus and the COVID-19 respiratory disease that it causes,” says a Bloomberg Law article.
It further says, “Now COVID-19 has infected 47 long-term care centers in Georgia, overwhelmed hospitals in New Orleans (Louisiana), spread into at least six Alabama nursing homes, forced the evacuation of scores of elderly residents from a Tennessee rehabilitation center and killed a country music star in Nashville (Tennessee).”
Why do the numbers say?
Based on a preliminary analysis of patients done by the US Centers for Disease Control and Prevention (CDC), Americans with underlying health conditions such as diabetes mellitus, chronic lung disease, and cardiovascular disease, appear to be at higher risk for severe COVID-19–associated disease than persons without these conditions.
“The percentage of COVID-19 patients in the US with at least one underlying health condition or risk factor was higher among those requiring intensive care unit (ICU) admission (358 of 457, 78%) and those requiring hospitalization without ICU admission (732 of 1,037, 71%) than that among those who were not hospitalized (1,388 of 5,143, 27%). The most commonly reported conditions were diabetes mellitus, chronic lung disease, and cardiovascular disease,” says the CDC.
These conditions also have a high prevalence among many of the southern states in the US, shows a study. According to America’s Health Rankings, an annual report by the nonprofit United Health Foundation, the bottom five worst-ranked states in the US are Oklahoma (rank 46), Alabama (47), Arkansas (48), Louisiana (49), and Mississippi (50). The states are ranked according to a score derived from 35 measures across five categories of health: behaviors, community & environment, policy, clinical care, and outcomes.
The numbers in the 2019 report are not a new trend. “Of the bottom 10 states, eight were in the bottom 10 in 2010, 2000 and 1990. This includes South Carolina (42), Kentucky (43), Tennessee (44), West Virginia (45), Alabama (47), Arkansas (48), Louisiana (49) and Mississippi (50),” says the report.
Mississippi's bottom rank in the report, for example, is driven by drops in the policy and the behaviors categories, say experts. The challenges the state faces are a high prevalence of obesity at 39.5% compared with 30.9% nationally. It also has a high cardiovascular death rate at 363.2 deaths per 100,000, compared with 260.4 deaths per 100,000 nationally, says the report.
Mississippi has a high infant mortality rate at 8.6 deaths per 1,000 live births, compared with 5.8 deaths per 1,000 live births nationally. “In the past five years, premature death increased by 7% in Mississippi, from 10,354 to 11,043 lost before age 75 per 100,000 population. Since 2012, diabetes increased 15% from 12.4% to 14.3% of adults,” say experts.
The number of adults with diabetes has also gone up in North Carolina, Tennessee, and Texas. Alabama also has a high prevalence of diabetes and high cardiovascular death rate. In the past 10 years, chlamydia increased 13% — from 543.5 to 614.1 cases per 100,000 population — in Alabama.
Yet another state, Louisiana, is a victim of high obesity prevalence, and a high cardiovascular death rate. “Since 2012, the percentage of the population without health insurance decreased by 60% from 20.3% to 8.2%. In the past seven years, the disparity in health status decreased 18% from 22.2% to 18.3%,” says the study. Chlamydia has also gone up in the last 10 years by 65%, from 451 to 742 cases per 100,000 population.
In Arkansas, the challenges include a high prevalence of obesity, a high percentage of children in poverty, and a high prevalence of frequent physical distress. In the past seven years, for example, diabetes has increased by 24% in the state — from 11.2% to 13.9% of adults.
Florida — which has an overall rank of 33 — has seen declines in the outcome category, particularly for disparity in health status increasing from 24.8% to 27.2% and diabetes significantly increasing from 10.5% to 12.6%. In Georgia too, diabetes has gone up by 24% since 2012, from 10.2% to 12.6%.
(AP Photo/Lynne Sladky)
Many states are also among the poorest
From 2017 to 2018, the South has been the only region in the US not to experience a decline in its poverty rate, according to a US Census Bureau report. The 2018 poverty rate for those in the South was 13.6%, representing 16.8 million individuals in poverty, with neither estimate statistically different from 2017. The South had the highest poverty rate in 2018 relative to the other three regions.
According to the report, the South region includes Alabama, Arkansas, Delaware, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, West Virginia, and the District of Columbia.
“The 2018 poverty rate and number in poverty for the Northeast was 10.3 percent and 5.7 million, down from 11.3 percent and 6.3 million in 2017. The 2018 poverty rate and number n poverty for the Midwest was 10.4 percent and 7.0 million, down from 11.2 percent and 7.6 million in 2017. Comparing 2017 and 2018, poverty rates declined in the West, while the number in poverty did not. The poverty rate for the West in 2018 was 11.2 percent, down from 11.9 percent in 2017 while the number in poverty was 8.7 million,” says the report.
And now COVID-19’s spreading in these states
Some of the worst affected among the 11 states as far as the number of confirmed cases are concerned are Louisiana (17,030), Florida (14,747, including 14,302 Florida residents and 445 non-Florida residents), Georgia (10,204), and Texas (9,353). Except for Florida (cases reported as of April 7), the other states have cases reported till April 8. Across the US, over 432,132 cases have been reported till April 9, and 14,817 have died in the COVID-19 pandemic, according to Johns Hopkins.
“COVID-19 is going to be a disaster in the Southeast. We’ll see higher morbidity, which is getting sick from the virus, and higher mortality, which is dying from the virus,” Aaron Milstone, a Tennessee pulmonologist, told Bloomberg Law.