Hard Lessons: The Impact of Secondary Education on COVID-19 Cases and Deaths in the U.S.

Abstract

Background: The association between education and health has been observed globally for a multitude of health measures. Variation in county-level COVID-19 burden in the United States (U.S.) provides an opportunity to identify community pandemic risk factors. We describe the influence of secondary education on county-level COVID-19 cases and deaths in the U.S.Methods: County-level environmental, social, behavioral, economic, political, regulatory, and health characteristics were obtained. Covariates used for modeling were selected from a candidate list through negative binomial stepwise forward selection with backwards elimination, as well as clinical judgement for prediction of COVID-19 cases and deaths. Counterfactual and bootstrap analyses estimated the impact of secondary education on COVID-19 mortality.Findings: High school dropout rate is one of the strongest predictors of COVID-19 cases (IRR 1.13, 95% CI 1.07; 1.18) and deaths (IRR 1.17, 95% CI 1.10; 1.26). Counterfactual analysis reducing the county-level high school dropout rate to the lowest in the nation resulted in a predicted 14.9% decrease in median county COVID-19 deaths per 100,000 (95% CI 6.98%; 22.82%). This hypothetical improvement in secondary education translated to approximately 57,680 preventable deaths throughout 2020 (95% CI: 30,654; 84,705).Interpretation: Adjusting for covariates, secondary education is among the strongest predictors of early county vulnerability to COVID-19 in the U.S. A reduction in high school dropout rate predicted a near 15% decrease in county COVID-19 mortality. Improving secondary education could strengthen the effectiveness of a community’s response to emerging threats such as a pandemic.Funding: None