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. 2022 Jan 13;22(1):81.
doi: 10.1186/s12889-021-12469-y.

Association between county-level risk groups and COVID-19 outcomes in the United States: a socioecological study

Sadiya S Khan  1   2 , Amy E Krefman  3 , Megan E McCabe  3 , Lucia C Petito  3 , Xiaoyun Yang  3 , Kiarri N Kershaw  3 , Lindsay R Pool  3 , Norrina B Allen  3
Affiliations

Association between county-level risk groups and COVID-19 outcomes in the United States: a socioecological study

Sadiya S Khan et al. BMC Public Health. .

Abstract

Background: Geographic heterogeneity in COVID-19 outcomes in the United States is well-documented and has been linked with factors at the county level, including sociodemographic and health factors. Whether an integrated measure of place-based risk can classify counties at high risk for COVID-19 outcomes is not known.

Methods: We conducted an ecological nationwide analysis of 2,701 US counties from 1/21/20 to 2/17/21. County-level characteristics across multiple domains, including demographic, socioeconomic, healthcare access, physical environment, and health factor prevalence were harmonized and linked from a variety of sources. We performed latent class analysis to identify distinct groups of counties based on multiple sociodemographic, health, and environmental domains and examined the association with COVID-19 cases and deaths per 100,000 population.

Results: Analysis of 25.9 million COVID-19 cases and 481,238 COVID-19 deaths revealed large between-county differences with widespread geographic dispersion, with the gap in cumulative cases and death rates between counties in the 90th and 10th percentile of 6,581 and 291 per 100,000, respectively. Counties from rural areas tended to cluster together compared with urban areas and were further stratified by social determinants of health factors that reflected high and low social vulnerability. Highest rates of cumulative COVID-19 cases (9,557 [2,520]) and deaths (210 [97]) per 100,000 occurred in the cluster comprised of rural disadvantaged counties.

Conclusions: County-level COVID-19 cases and deaths had substantial disparities with heterogeneous geographic spread across the US. The approach to county-level risk characterization used in this study has the potential to provide novel insights into communicable disease patterns and disparities at the local level.

Keywords: COVID-19; Communicable diseases; County-level health; Pandemic.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Nationwide Distribution of (A) County-Level Risk Groups (B) COVID-19 deaths per 100,000 and (C) COVID-19 cases per 100,00 from 1/21/20 to 2/17/21
Fig. 2
Fig. 2
Association between county-level risk group and cumulative COVID-19 (A) deaths and (B) cases per 100,000 population from 1/21/20 to 2/17/21*
Fig. 3
Fig. 3
Spatiotemporal patterns of COVID-19 spread in the ten counties with the highest cumulative COVID-19 deaths per 100,000 from 1/21/20 to 2/17/21 within each county-level risk grouping
See this image and copyright information in PMC

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