Abstract
This study compared 2019 values for the National Health Security Preparedness Index (NHSPI) with 2020 rates of coronavirus disease 2019 (COVID-19)-related mortality as reported by the 50 US states and Puerto Rico during the first six months of the US pandemic (March 1 - August 31, 2020). Data regarding provisional death counts and estimates of excess deaths for COVID-19 according to state and territory were downloaded from the Centers for Disease Control and Prevention (CDC) National Center for Health Statistics website. Reporting included the six-month-long period of March 1 - August 31, 2020. Excess mortality rates were calculated as the number of excess deaths per 100,000 persons in each state population using 2019 US Census Bureau data. Mean values for state and territorial NHSPI domain indices were compared to state and territorial rates of COVID-19-related excess mortality using multiple linear regression, including analysis of variance. Correlations between the 51 state and territorial NHSPI values and corresponding COVID-19 excess mortality rates were calculated using Pearson's correlation coefficient. These calculations revealed a high degree of variance (adjusted r square = 0.02 and 0.25) and poor correlation (P = .16 and .08) among values for the overall NHSPI as compared to low and high estimates of excess COVID-19 mortality rates for 50 US states and Puerto Rico.There was also a high degree of variance (adjusted r square = 0.001 and 0.03) and poor correlation (P values ranging from .09 to .94) for values for the six individual domains of the NHSPI as compared to low and high estimates of excess COVID-19 mortality rates for 50 US states and Puerto Rico. The NHSPI does not appear to be a valid predictor of excess COVID-19 mortality rates for 50 US states and Puerto Rico during the first six months of the pandemic.
Highlights
This study evaluated the validity of the NHSPI for predicting excess COVID-19-related mortality
The lower and upper estimates of excess mortality were calculated as the difference between the observed count and one of two thresholds by jurisdiction
Correlations between the 51 NHSPI values and corresponding COVID-19 excess mortality rates were calculated using Pearson’s correlation coefficient. In general, these calculations failed to demonstrate any significant association between values of the overall NHSPI and excess COVID-19 mortality rates for 50 US states and Puerto Rico
Summary
NHSPI as Predictor of Excess COVID-19 Mortality to have been “shown to be important in protecting people from the health consequences of disasters and other large-scale hazards and emergencies.”[5]. Validity is central to determining the utility of any scale. Validity describes a test’s ability to produce results consistent with other measures of the same characteristic and it requires external criteria.[6] Predictive validity is considered to be achieved when there is significant correlation between an experimental test (eg, the NHSPI) and a reference criterion standard (eg, excess coronavirus disease 2019 [COVID-19] mortality). This study evaluated the validity of the NHSPI for predicting excess COVID-19-related mortality
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