Theses and Dissertations

Healthcare in a Time of Crisis: An Investigation of the Association Between Socioeconomic Status, Counties, and COVID-19

Jorge F. Contreras Valdez, The University of Texas Rio Grande Valley

Copyright 2023 The Author. All Rights Reserved.


The COVID-19 pandemic has stressed social structural institutions such as hospitals, schools, the economy, and governmental bodies (local, state, and federal), exacerbating existing health inequality. Fundamental Cause Theory (FCT) provides a framework for understanding which factors drive such inequality, but its primary focus is on within-group variation. By highlighting the role of fundamental causes as systems of exposure, the Systems-of-Exposure (SOE) approach expands on FCT to account for variation more directly between populations. I performed a Qualitative Comparative Analysis (QCA) of county-level data from Texas and California to test the utility of SOE in assessing the impact of a pandemic on health. The 2019 American Community Survey (ACS) and the 2019 County Health Rankings (CHR) was used to capture the sociodemographic, health related, and political characteristics of a county. Looking at the counties from California and Texas, I found that Texas counties were in more extended period of high COVID-19 transmission levels. outcomes than California. SOE provides useful differential framework over FCT that can be used for other pandemics and major health events to look at the impact of systems of exposure onto health.