# The Role of Testing and Vaccination in Mediating Social Vulnerability and COVID-19 Prevalence in Southern Nevada

## TL;DR

This study explores how testing and vaccination rates affect the relationship between social vulnerability and COVID-19 prevalence in Southern Nevada.

## Contribution

The novel contribution is identifying how testing and vaccination rates mediate the impact of social vulnerability on reported COVID-19 cases.

## Key findings

- Testing rates were lower in areas with higher social vulnerability, leading to more undetected cases.
- Vaccination rates significantly mediated the relationship between social vulnerability and COVID-19 prevalence.
- Higher social vulnerability is linked to reduced testing and vaccination rates, contributing to underreported cases.

## Abstract

The COVID-19 pandemic is a catastrophic event highlighting numerous health disparities. The social vulnerability index (SVI) has been widely utilized in COVID-19 research to assess vulnerable communities and to examine how social determinants influence various COVID-19 outcomes. This population-based study aims to determine whether COVID-19 testing and vaccination rates mediate the relationship between the SVI and COVID-19 prevalence. Mediation analysis was conducted using data from 535 census tracts in Clark County, Nevada. Findings indicate that COVID-19 testing rates were lower in areas with high SVI scores, potentially leading to more undetected cases. Moreover, COVID-19 testing, full vaccination, and follow-up vaccination rates significantly mediated the relationship between SVI and COVID-19 prevalence. These results suggest that greater location-based social vulnerability is associated with a sequential pathway of reduced testing and vaccination rates, contributing to underreported COVID-19 cases.