The End of the SAVA Syndemics? Spatial and Temporal Patterns of Syndemic Mortality across U.S. Counties

• In Event: 40458 - Social Dimensions of Infectious Disease

Abstract

Objectives.
To determine whether and how mortality patterns related to substance use, violence, and infectious diseases (the SAVA syndemic) vary across U.S. counties during the post-antiretroviral therapy era (2000-2019).
Methods.
We analyzed mortality data from the U.S. National Vital Statistics System for 3,079 counties using multilevel mixture model to examine syndemic mortality patterns, followed by fixed-effects regressions to estimate associations with county-level social determinants.
Results. We identified two distinct syndemic mortality processes. Counties with increased physician density (β = -0.037, 95% CI[-0.074, -0.001]) and recreational facilities (β = -0.161, 95% CI[-0.241, -0.08]) showed lower infectious diseases mortality risks, particularly in Southeast coastal regions. Counties with higher educational attainment (β = -0.205, 95% CI[-0.279, -0.131]) and physician density (β = -0.040, 95% CI[-0.063, -0.018]) demonstrated reduced risks of co-occurring behavioral health mortality (β = -0.205 to -0.040, p < .05), especially in Western regions where these mortality causes were concentrated.
Conclusions.
Multiple health conditions cluster and evolve differently across geographic spaces, shaped by distinct social and institutional forces. This study provides a framework for understanding how space-based determinants create and sustain cycles of multiple health risks.
Public Health Implications.
Health initiatives should focus on strengthening place-based resources—from healthcare infrastructure to community support networks—that can simultaneously address multiple interacting health conditions within specific local contexts.

Authors

• Shao-Tzu Yu, Princeton University

• Sanyu A. Mojola, Princeton University

• Krzysztof Sakrejda3, University of Michigan

• Jon Zelner, University of Michigan