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We used a case-control design to\u00a0examine the association between area-level social vulnerability and severe COVID-19 using electronic health records (EHR) from a regional health information hub in the greater Philadelphia region. Severe COVID-19 cases (<jats:italic>n<\/jats:italic>\u2009=\u200915,464 unique patients) were defined as those with an inpatient admission and a diagnosis of COVID-19 in 2020. Controls (<jats:italic>n<\/jats:italic>\u2009=\u200978,600; 5:1 control-case ratio) were a random sample of individuals who did not have a COVID-19 diagnosis from the same geographic area. Retrospective data on comorbidities and demographic variables were extracted from EHR and linked to area-level social vulnerability index (SVI) data using ZIP codes. Models adjusted for different sets of covariates showed incidence rate ratios (IRR) ranging from 1.15 (95% CI, 1.13\u20131.17) in the model adjusted for individual-level age, sex, and marital status to 1.09 (95% CI, 1.08\u20131.11) in the fully adjusted model, which included individual-level comorbidities and race\/ethnicity. The fully adjusted model indicates that a 10% higher area-level SVI was associated with a 9% higher risk of severe COVID-19. Individuals in neighborhoods with high social vulnerability were more likely to have severe COVID-19 after accounting for comorbidities and demographic characteristics. Our findings support initiatives incorporating neighborhood-level social determinants of health when planning interventions and allocating resources to mitigate epidemic respiratory diseases, including other coronavirus or influenza viruses.<\/jats:p>","DOI":"10.1007\/s11524-024-00876-6","type":"journal-article","created":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T18:01:55Z","timestamp":1715623315000},"page":"845-855","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Area-Level Social Vulnerability and Severe COVID-19: A Case\u2013Control Study Using Electronic Health Records from Multiple Health Systems in the Southeastern Pennsylvania Region"],"prefix":"10.1007","volume":"101","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4758-3875","authenticated-orcid":false,"given":"Pricila H.","family":"Mullachery","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Usama","family":"Bilal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ran","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leslie A.","family":"McClure","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,5,13]]},"reference":[{"issue":"7","key":"876_CR1","doi-asserted-by":"publisher","first-page":"936","DOI":"10.7326\/M20-3936","volume":"174","author":"U Bilal","year":"2021","unstructured":"Bilal U, Tabb LP, Barber S, Diez Roux AV. 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