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. 2021 Dec:64:76-82.
doi: 10.1016/j.annepidem.2021.08.020. Epub 2021 Sep 6.

Social vulnerability and county stay-at-home behavior during COVID-19 stay-at-home orders, United States, April 7-April 20, 2020

Kelly M Fletcher  1 , Julie Espey  2 , Marissa K Grossman  2 , J Danielle Sharpe  2 , Frank C Curriero  3 , Grete E Wilt  2 , Gregory Sunshine  4 , Amanda Moreland  4 , Mara Howard-Williams  4 , J Gabriel Ramos  5 , Danilo Giuffrida  5 , Macarena C García  4 , William M Hartnett  2 , Stephanie Foster  2
Affiliations

Social vulnerability and county stay-at-home behavior during COVID-19 stay-at-home orders, United States, April 7-April 20, 2020

Kelly M Fletcher et al. Ann Epidemiol. 2021 Dec.

Abstract

Purpose: Early COVID-19 mitigation relied on people staying home except for essential trips. The ability to stay home may differ by sociodemographic factors. We analyzed how factors related to social vulnerability impact a community's ability to stay home during a stay-at-home order.

Methods: Using generalized, linear mixed models stratified by stay-at-home order (mandatory or not mandatory), we analyzed county-level stay-at-home behavior (inferred from mobile devices) during a period when a majority of United States counties had stay-at-home orders (April 7-April 20, 2020) with the Centers for Disease Control and Prevention Social Vulnerability Index (CDC SVI).

Results: Counties with higher percentages of single-parent households, mobile homes, and persons with lower educational attainment were associated with lower stay-at-home behavior compared with counties with lower respective percentages. Counties with higher unemployment, higher percentages of limited-English-language speakers, and more multi-unit housing were associated with increases in stay-at-home behavior compared with counties with lower respective percentages. Stronger effects were found in counties with mandatory orders.

Conclusions: Sociodemographic factors impact a community's ability to stay home during COVID-19 stay-at-home orders. Communities with higher social vulnerability may have more essential workers without work-from-home options or fewer resources to stay home for extended periods, which may increase risk for COVID-19. Results are useful for tailoring messaging, COVID-19 vaccine delivery, and public health responses to future outbreaks.

Keywords: COVID-19; GIS; Generalized linear mixed effect model; Population movement; Social vulnerability; Spatial analysis; Stay-at-home order.

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Figures

Fig 1
Fig. 1
County-level bivariate map comparing overall 2018 CDC Social Vulnerability Index (SVI) to median stay-at-home behavior (April 7–20, 2020), United States.
See this image and copyright information in PMC

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