Identification of county-level health factors associated with COVID-19 mortality in the United States

Abstract Background Geographic heterogeneity in COVID-19 outcomes in the United States is well-documented and has been linked with factors at the county level, including sociodemographic and health factors. Whether an integrated measure of place-based risk can classify counties at high risk for COVID-19 outcomes is not known. Methods We conducted an ecological nationwide analysis of 2,701 US counties from 1/21/20 to 2/17/21. County-level characteristics across multiple domains, including demographic, socioeconomic, healthcare access, physical environment, and health factor prevalence were harmonized and linked from a variety of sources. We performed latent class analysis to identify distinct groups of counties based on multiple sociodemographic, health, and environmental domains and examined the association with COVID-19 cases and deaths per 100,000 population. Results Analysis of 25.9 million COVID-19 cases and 481,238 COVID-19 deaths revealed large between-county differences with widespread geographic dispersion, with the gap in cumulative cases and death rates between counties in the 90th and 10th percentile of 6,581 and 291 per 100,000, respectively. Counties from rural areas tended to cluster together compared with urban areas and were further stratified by social determinants of health factors that reflected high and low social vulnerability. Highest rates of cumulative COVID-19 cases (9,557 [2,520]) and deaths (210 [97]) per 100,000 occurred in the cluster comprised of rural disadvantaged counties. Conclusions County-level COVID-19 cases and deaths had substantial disparities with heterogeneous geographic spread across the US. The approach to county-level risk characterization used in this study has the potential to provide novel insights into communicable disease patterns and disparities at the local level.

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Contextual Factors Associated With County-Level Suicide Rates in the United States, 1999 to 2016

JAMA Network Open ◽

10.1001/jamanetworkopen.2019.10936 ◽

2019 ◽

Vol 2 (9) ◽

pp. e1910936 ◽

Cited By ~ 16

Author(s):

Danielle L. Steelesmith ◽

Cynthia A. Fontanella ◽

John V. Campo ◽

Jeffrey A. Bridge ◽

Keith L. Warren ◽

...

Keyword(s):

United States ◽

Contextual Factors ◽

The United States ◽

County Level ◽

Factors Associated ◽

Suicide Rates

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Risk factors associated with mortality of COVID-19 in 3125 counties of the United States

10.1101/2020.05.18.20105544 ◽

2020 ◽

Author(s):

Ting Tian ◽

Jingwen Zhang ◽

Liyuan Hu ◽

Yukang Jiang ◽

Congyuan Duan ◽

...

Keyword(s):

United States ◽

Risk Factors ◽

Negative Binomial ◽

The United States ◽

Outdoor Environment ◽

Local Health ◽

County Level ◽

Factors Associated ◽

High Prevalence ◽

The Impact

Background The number of cumulative confirmed cases of COVID-19 in the United States has risen sharply since March 2020. A county health ranking and roadmaps program has been established to identify factors associated with disparity in mobility and mortality of COVID-19 in all counties in the United States. Methods To find out the risk factors associated with county-level mortality of COVID-19 with various levels of prevalence, a negative binomial design was applied to the county-level mortality counts of COVID-19 as of August 27, 2020 in the United States. In this design, the infected counties were categorized into three levels of infections using clustering analysis based on time-varying cumulative confirmed cases from March 1 to August 27, 2020. COVID-19 patients were not analyzed individually but were aggregated at the county-level, where the county-level deaths of COVID-19 confirmed by the local health agencies. Results 3125 infected counties were assigned into three classes corresponding to low, median, and high prevalence levels of infection. Several risk factors were significantly associated with the mortality counts of COVID-19, where higher level of air pollution (0.153, P<0.001) increased the mortality in the low prevalence counties and elder individuals were more vulnerable in both the median and high prevalence counties . The segregation between non-Whites and Whites and higher Hispanic population had higher likelihood of risk of the deaths in all infected counties. Conclusions The mortality of COVID-19 depended on sex, race/ethnicity, and outdoor environment. The increasing awareness of the impact of these significant factors may lead to the reduction in the mortality of COVID-19.

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Risk factors associated with mortality of COVID-19 in 3125 counties of the United States

Infectious Diseases of Poverty ◽

10.1186/s40249-020-00786-0 ◽

2021 ◽

Vol 10 (1) ◽

Author(s):

Ting Tian ◽

Jingwen Zhang ◽

Liyuan Hu ◽

Yukang Jiang ◽

Congyuan Duan ◽

...

Keyword(s):

United States ◽

Risk Factors ◽

Clustering Analysis ◽

Negative Binomial ◽

The United States ◽

Outdoor Environment ◽

Local Health ◽

County Level ◽

Factors Associated ◽

The Impact

Abstract Background The number of cumulative confirmed cases of COVID-19 in the United States has risen sharply since March 2020. A county health ranking and roadmaps program has been established to identify factors associated with disparity in mobility and mortality of COVID-19 in all counties in the United States. The risk factors associated with county-level mortality of COVID-19 with various levels of prevalence are not well understood. Methods Using the data obtained from the County Health Rankings and Roadmaps program, this study applied a negative binomial design to the county-level mortality counts of COVID-19 as of August 27, 2020 in the United States. In this design, the infected counties were categorized into three levels of infections using clustering analysis based on time-varying cumulative confirmed cases from March 1 to August 27, 2020. COVID-19 patients were not analyzed individually but were aggregated at the county-level, where the county-level deaths of COVID-19 confirmed by the local health agencies. Clustering analysis and Kruskal–Wallis tests were used in our statistical analysis. Results A total of 3125 infected counties were assigned into three classes corresponding to low, median, and high prevalence levels of infection. Several risk factors were significantly associated with the mortality counts of COVID-19, where higher level of air pollution (0.153, P < 0.001) increased the mortality in the low prevalence counties and elder individuals were more vulnerable in both the median (0.049, P < 0.001) and high (0.114, P < 0.001) prevalence counties. The segregation between non-Whites and Whites (low: 0.015, P < 0.001; median:0.025, P < 0.001; high: 0.019, P = 0.005) and higher Hispanic population (low and median: 0.020, P < 0.001; high: 0.014, P = 0.009) had higher likelihood of risk of the deaths in all infected counties. Conclusions The mortality of COVID-19 depended on sex, race/ethnicity, and outdoor environment. The increasing awareness of the impact of these significant factors may help decision makers, the public health officials, and the general public better control the risk of pandemic, particularly in the reduction in the mortality of COVID-19. Graphic abstract

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