Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Dec 12:3:1229718.
doi: 10.3389/fepid.2023.1229718. eCollection 2023.

State-level public health preparedness indices as predictors of COVID-19 mortality outcomes: results from the United States of America in 2020

Matthew R Boyce  1
Affiliations

State-level public health preparedness indices as predictors of COVID-19 mortality outcomes: results from the United States of America in 2020

Matthew R Boyce. Front Epidemiol. .

Abstract

This study evaluates associations between state-level preparedness indices and reported COVID-19-related mortality outcomes in all 50 states and the District of Columbia in the United States of America during three distinct time periods throughout the first year of the COVID-19 pandemic. State-level preparedness data for the year 2019 were gathered from the National Health Security Preparedness and Trust for America's Health Indices, and COVID-19-related mortality data for March-December 2020 (i.e., excess mortality and reported COVID-19 mortality rates) were collected in May 2022. Linear regression analyses were conducted to examine associations during three distinct time periods. Statistically significant positive associations were observed between both indices and reported COVID-19 mortality rates during the first time period. A statistically significant negative association was observed between one preparedness index and excess mortality during the second time period. No other significant associations existed for the outcomes or time periods considered in this analysis. These results demonstrate that state-level preparedness indices were not well attuned to COVID-19-related mortality outcomes during the first year of the pandemic. This suggests that current measures of state-level preparedness may be underinclusive and require a reconceptualization to improve their utility for public health practice.

Keywords: COVID-19; assessment; health security; mortality; preparedness; public health.

PubMed Disclaimer

Conflict of interest statement

The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
State-level preparedness as measured by the National Health Security Preparedness Index and the Trust for America's Health Index versus excess mortality rates per 100,000 population.
Figure 2
Figure 2
State-level preparedness as measured by the National Health Security Preparedness Index and the Trust for America's Health Index versus reported COVID-19 mortality rates per 100,000 population.
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. United States Government. United States health security national action plan: Strengthening implementation of the international health regulations based on the 2016 joint external evaluation. Washington, DC: United States Government; (2018).
    1. Trust for America’s Health. Ready or not: protecting the public’s health from diseases, disasters, and bioterrorism—2020 issue report. Washington, DC: Trust for America’s Health; (2020).
    1. National Health Security Preparedness Index. Toolkit: 2020 archives. Available at: https://nhspi.org/tools-resources/ (Accessed May 05, 2022).
    1. Haider N, Yavlinsky A, Chang YM, Hasan MN, Benfield C, Osman AY, et al. The global health security index and joint external evaluation score for health preparedness are not correlated with countries’ COVID-19 detection response time and mortality outcome. Epidemiol Infect. (2020) 148(e210):1–8. 10.1017/S0950268820002046 - DOI - PMC - PubMed
    1. Baum F, Freeman T, Musolino C, Abramovitz M, De Ceukelaire W, Flavel J, et al. Explaining COVID-19 performance: what factors might predict national responses? Br Med J . (2021) 372:n91. 10.1136/bmj.n91 - DOI - PMC - PubMed

LinkOut - more resources