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. 2021 Oct 5;73(7):e1814-e1821.
doi: 10.1093/cid/ciaa1729.

County-level Predictors of Coronavirus Disease 2019 (COVID-19) Cases and Deaths in the United States: What Happened, and Where Do We Go from Here?

John M McLaughlin  1 , Farid Khan  1 , Sarah Pugh  1 , Frederick J Angulo  1 , Heinz-Josef Schmitt  1 , Raul E Isturiz  1 , Luis Jodar  1 , David L Swerdlow  1
Affiliations

County-level Predictors of Coronavirus Disease 2019 (COVID-19) Cases and Deaths in the United States: What Happened, and Where Do We Go from Here?

John M McLaughlin et al. Clin Infect Dis. .

Abstract

Background: The United States has been heavily impacted by the coronavirus disease 2019 (COVID-19) pandemic. Understanding microlevel patterns in US rates of COVID-19 can inform specific prevention strategies.

Methods: Using a negative binomial mixed-effects regression model, we evaluated the associations between a broad set of US county-level sociodemographic, economic, and health status-related characteristics and cumulative rates of laboratory-confirmed COVID-19 cases and deaths between 22 January 2020 and 31 August 2020.

Results: Rates of COVID-19 cases and deaths were higher in US counties that were more urban or densely populated or that had more crowded housing, air pollution, women, persons aged 20-49 years, racial/ethnic minorities, residential housing segregation, income inequality, uninsured persons, diabetics, or mobility outside the home during the pandemic.

Conclusions: To our knowledge, this study provides results from the most comprehensive multivariable analysis of county-level predictors of rates of COVID-19 cases and deaths conducted to date. Our findings make clear that ensuring that COVID-19 preventive measures, including vaccines when available, reach vulnerable and minority communities and are distributed in a manner that meaningfully disrupts transmission (in addition to protecting those at highest risk of severe disease) will likely be critical to stem the pandemic.

Keywords: disparities; risk-factors; transmission; vaccine distribution; vulnerable populations.

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