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. 2020 Jun;36(3):433-445.
doi: 10.1111/jrh.12476. Epub 2020 Jun 16.

Spatial Disparities in Coronavirus Incidence and Mortality in the United States: An Ecological Analysis as of May 2020

Charlie H Zhang  1 , Gary G Schwartz  2
Affiliations

Spatial Disparities in Coronavirus Incidence and Mortality in the United States: An Ecological Analysis as of May 2020

Charlie H Zhang et al. J Rural Health. 2020 Jun.

Abstract

Purpose: This ecological analysis investigates the spatial patterns of the COVID-19 epidemic in the United States in relation to socioeconomic variables that characterize US counties.

Methods: Data on confirmed cases and deaths from COVID-19 for 2,814 US counties were obtained from Johns Hopkins University. We used Geographic Information Systems (GIS) to map the spatial aspects of this pandemic and investigate the disparities between metropolitan and nonmetropolitan communities. Multiple regression models were used to explore the contextual risk factors of infections and death across US counties. We included population density, percent of population aged 65+, percent population in poverty, percent minority population, and percent of the uninsured as independent variables. A state-level measure of the percent of the population that has been tested for COVID-19 was used to control for the impact of testing.

Findings: The impact of COVID-19 in the United States has been extremely uneven. Although densely populated large cities and their surrounding metropolitan areas are hotspots of the pandemic, it is counterintuitive that incidence and mortality rates in some small cities and nonmetropolitan counties approximate those in epicenters such as New York City. Regression analyses support the hypotheses of positive correlations between COVID-19 incidence and mortality rates and socioeconomic factors including population density, proportions of elderly residents, poverty, and percent population tested.

Conclusions: Knowledge about the spatial aspects of the COVID-19 epidemic and its socioeconomic correlates can inform first responders and government efforts. Directives for social distancing and to "shelter-in-place" should continue to stem the spread of COVID-19.

Keywords: COVID-19; metropolitan areas; pandemic; rural or nonmetropolitan; spatial disparities.

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Figures

Figure 1
Figure 1
Average Incidence Rates of Confirmed Cases and Deaths from COVID‐19 Pandemic for US Counties Classified by USDA Urban‐Rural Locale Codes (2013).
Figure 2
Figure 2
Average Incidence and Mortality Rates in Urban, Suburban, and Rural Counties in the United States.
Figure 3
Figure 3
Map of Confirmed Cases of COVID‐19 (per 100,000 population) in the Conterminous 48 States.
Figure 4
Figure 4
Map of Deaths from COVID‐19 (per 100,000 population) in the Conterminous 48 States.
See this image and copyright information in PMC

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