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Sherry Zink of BlueCross BlueShield of Tennessee / Contributed photo

Health data from BlueCross BlueShield of Tennessee is providing insight into what makes some people more vulnerable to COVID-19 and less likely to accept vaccines.

As with many diseases and health conditions, a person's access to health care, income, education and physical environment — such as a neighborhood or workplace — heavily influence whether that individual gets sick or dies due to the coronavirus. These "social determinants of health" help explain why COVID-19 has hit minority populations in Tennessee and the United States harder.

"We're seeing a lot of those health disparities across those populations that are testing positive for COVID-19 as well as those who may have some more severe cases of COVID-19," said Sherri Zink, vice president and chief data engagement officer at BlueCross. For example, not only are COVID-19 cases and hospitalizations more prevalent in minority communities, hospitalizations among Black and Hispanic people are occurring in much younger age groups, according to BlueCross's data analysis.

BlueCross found similar results among its Medicaid members. About 9% of BlueCross's Medicaid members have tested positive for COVID-19, but Black people account for 50% of those testing positive and 72% of the high-severity cases.

In response, BlueCross used its data to develop a "Social Vulnerabilities Index" for members — an aggregate score that ranges from 0 to 19 based on the number of social determinants that could put that member at risk.

"For those people who are at high risk factor of COVID-19, we layer on that social vulnerability index to give us an idea of what are those other factors that may drive their risk even higher for either contracting COVID-19 or having a severe reaction to the disease," Zink said.

In partnership with Nashville's Meharry Medical College, the largest private historically Black college in the United States, BlueCross is using this information now to better address these disparities and apply what it is learning to improve vaccine acceptance rates among underserved groups.

"We know from other data that there's more hesitancy in Black and Latino populations," said Dr. Bryan Heckman, director of the Center for the Study of Social Determinants of Health at Meharry. "A lot of that has to do with trust — there's a fair amount of mistrust in minority populations based off some real things that have happened in the past."

In addition to identifying barriers, such as transportation issues, Heckman said that overcoming distrust and combating widespread misinformation will be key in order to improve COVID-19 disparities and increase vaccine acceptance in underserved communities. One way to do that is working alongside trusted messengers, such as churches and other faith-based organizations.

Using BlueCross's data, the group created maps to identify regions that may be more hesitant in order to develop programs and decide where to allocate resources as the program evolves.

"We might be able to use our mobile units to actually go out and engage with those communities throughout the state, or create public health messaging that could be focused on certain areas, depending on the issues at hand," Heckman said. "If we understand what was creating the vulnerability, then we can help overcome it."

Contact Elizabeth Fite at or follow her on Twitter @ecfite.