Abstract
To examine the association between local health department (LHD) accreditation and COVID-19 community outcomes, including rates of adult vaccination, hospitalization, and death. We examined county level rates of adult vaccination, hospitalization, and death by LHD accreditation status over the course of the COVID pandemic. Additional independent variables included time period, COVID-19 Community Vulnerability Index (CCVI), state public health governance structure, and state policy environment. We used hierarchal linear mixed modeling with random intercept for county level data to account for repeated observations and fixed effects for all other variables. This study examined all communities in the United States of America. LHDs and the communities they serve. Rates of adult vaccination, hospitalization, and death due to COVID-19. Among accredited LHDs, the adult population was more likely to be fully vaccinated when compared to unaccredited LHDs ( P <.01). Additional variables in the model, which were also significant, included time period, CCVI, state policy environment, and state public health governance structure. There were no significant differences in the hospitalization rates in jurisdictions with an accredited LHD compared to jurisdictions where the LHD is not accredited. Death rates in jurisdictions with an accredited LHD were statistically significantly lower than death rates in jurisdictions where the health department was not accredited ( P <.001). This relationship was significant with other key variables in the model, including time, CCVI, state policy environment, and state public health governance structure. This study demonstrates that there is an association between LHD accreditation and community health outcomes. Furthermore, we found that other factors, such as social determinants of health, state policy environment, and state public health governance structure impact community health outcomes.
Published Version
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