Abstract
BackgroundGeographic 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.MethodsWe 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.ResultsAnalysis 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.ConclusionsCounty-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.
Highlights
Since the first case of the coronavirus disease 2019 (COVID-19) was confirmed in the United States (US) in Snohomish county, Washington, on January 21st, 2020 [1, 2], the US has experienced more cases (99,467 cases perKhan et al BMC Public Health (2022) 22:81 health that may contribute to observed differences in COVID-19 outcomes [9, 10].Understanding how place-based disadvantage has influenced COVID-19 case and death rates is critical for developing strategies to address long-term sequalae of COVID-19 [11] and to target vaccination efforts [12] at the local level
Several studies have focused on single social and environmental factors or grouped factors based on existing county-level rankings to examine differences at the county-level in COVID-19 outcomes
This study sought to use a novel method for clustering, latent class analysis, to identify meaningful groups of counties based on county-level characteristics across multiple sociodemographic, health, and environmental domains and to examine associations with COVID-19 cases and deaths
Summary
Understanding how place-based disadvantage has influenced COVID-19 case and death rates is critical for developing strategies to address long-term sequalae of COVID-19 [11] and to target vaccination efforts [12] at the local level. This is especially important given the significant geographic heterogeneity observed in the burden of COVID-19 with large differences in morbidity and mortality among counties within the US [13, 14]. Whether an integrated measure of place-based risk can classify counties at high risk for COVID-19 outcomes is not known
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