Assessing the Relationship Between Resources Availability and COVID19 Mortality Among US Counties

Abstract

RESEARCH OBJECTIVE: The coronavirus disease of 2019 (COVID-19) which was declared a pandemic by the World Health Organization in March of 2020 has claimed the lives of millions of people around the world. The United States leads all countries worldwide in the number of COVID-19 related deaths. Individual level factors such as preexisting conditions and demographics along with county level factors such as availability of resources have been attributed to increased risk of COVID-19 related death. This study seeks to build on previous studies to assess the relationship between the level of health care resources and COVID-19 mortality among U.S. counties. STUDY DESIGN: We merged 2019 data from the American Hospital Association (AHA) Annual Survey of Hospitals, Area Health Resources Files (AHRF), and USA FACTS. The final sample consisted of 2,395 counties in the United States. The dependent variable was the number of COVID-19-related deaths by county. Independent variables were county level resources which included the number of airborne infection control rooms, average occupancy rate, number of full-time equivalent hospitalists and registered nurses (RN), hospital spending per capita, number of Joint Commission accredited and teaching hospitals, and total skilled nursing facilities beds. We controlled for the percentage of the population 65 years and older. Ordinary least square regression was used to determine the relationship between the level of health care resources and number of COVID-19 deaths. PRINCIPAL FINDINGS: The level of health care resources was significantly associated with COVID-19 related mortality. An increase in FTE Registered Nurses (ß = -0.0002; p<0.001), hospital spending per capita (ß = -0.0001; p<0.001) and teaching hospitals in the county (ß = -0.2063; p<0.001) were associated with a decrease in COVID-19 related deaths. However, an increase in the number of airborne infection control rooms (ß = 0.0071; p<0.001), average occupancy rate (ß = 0.0102; p<0.001), total skilled nursing facilities beds (ß = 0.0003; p<0.001), FTE hospitalists (ß = 0.0204; p<0.001), per capita income (ß = 0.0001; p<0.001), and Joint Commission hospitals in the county (ß = 0.0767; p<0.001) were associated with an increase in COVID-19 related deaths in the county. For each increase in the percentage of population 65 years and older, there was a decrease in the COVID-19 related deaths (ß = -0.0771; p<0.001). CONCLUSION: The availability of resources such as the presence of teaching hospitals, increased spending per capita, and adequate number of nurses to better care for patient may lead to a reduction in COVID-19 related death.