Determinants of COVID-19 Case Fatality Rate in the US: Spatial Analysis Over One Year of the Pandemic

Abstract

Background: The United States continues to account for the highest proportion of the global Coronavirus Disease-2019 (COVID-19) cases and deaths. Currently, it is important to contextualize COVID-19 fatality to guide mitigation efforts. Objectives: The objective of this study was to assess the ecological factors (policy, health behaviors, socio-economic, physical environment, and clinical care) associated with COVID-19 case fatality rate (CFR) in the United States. Methods: Data from the New York Times’ COVID-19 repository and the Centers for Disease Control and Prevention Data (01/21/2020 - 02/27/2021) were used. County-level CFR was modeled using the Spatial Durbin model (SDM). The SDM estimates were decomposed into direct and indirect impacts. Results: The study found percent positive for COVID-19 (0.057% point), stringency index (0.014% point), percent diabetic (0.011% point), long-term care beds (log) (0.010% point), premature age-adjusted mortality (log) (0.702 % point), income inequality ratio (0.078% point), social association rate (log) (0.014% point), percent 65 years old and over (0.055% point), and percent African Americans (0.016% point) in a given county were positively associated with its COVID-19 CFR. The study also found food insecurity, long-term beds (log), mental health-care provider (log), workforce in construction, social association rate (log), and percent diabetic of a given county as well as neighboring county were associated with given county’s COVID-19 CFR, indicating significant externalities. Conclusion: The spatial models identified percent positive for COVID-19, stringency index, elderly, college education, race/ethnicity, residential segregation, premature mortality, income inequality, workforce composition, and rurality as important ecological determinants of the geographic disparities in COVID-19 CFR.

Higher hospitalization and mortality rates among SARS-CoV-2 infected Persons in Rural America

“…43 A recent study conducted using spatial models in the US found rurality to be one of several ecologic determinants of C19 mortality. 44 Our results again raise the question of why rural populations experience higher mortality rates after adjustment for multiple factors, even with a new pathogen such as SARS-CoV-2. To what extent delays in care contribute to increased SARS-CoV-2 related mortality among rural populations is unclear as is the potential impact of environmental risk factors in rural areas.…”

“…Previous large-scale studies have been restricted to single states 11 or utilized public health reporting systems. 12 While the relationship between rural and urban hospitalization and mortality has been studied for chronic conditions, limited research has evaluated SARS-CoV-2 infected rural-urban discrepancies.…”

Use of informatics to characterise the exposome of COVID-19

“…Recent studies show that ecological factors (policy, health behaviours, physical environment and clinical care) are associated with COVID-19 case fatality rate. 5 Furthermore, exposure to ultraviolet radiation favours the synthesis of vitamin D in the body, which plays an important role in the immune defence against viral and bacterial infections. 6 Additionally, a relevant correlation has been found between exposure to particulate matter (pollution) and COVID-19 death rates.…”

Understanding the Geography of COVID-19 Case Fatality Rates in China: A Spatial Autoregressive Probit-Log Linear Hurdle Analysis

“…The ongoing coronavirus disease 2019 (COVID- 19), as a rapidly spreading global pandemic, comes as a big blow to the economic and social development of the world and has become a global health concern. Case fatality rate (CFR), known as the proportion of deaths from a kind of disease to the number of confirmed cases of this disease (the proportion of infected people who die), is an important indicator to measure the severity degree of the epidemic (1), as well as a reflection of the government capacity to prevent and control the epidemic (2).…”

“…As an essential environmental factor, climatic conditions also influence the death rates of COVID-19 (11), mainly measured by temperature and air humidity (12)(13)(14). Demographic characteristics have remarkable effects on the mortality of patients with COVID-19: age is the dominant factor; besides, gender, race, ethnicity, medical history (such as comorbidity and obesity), and neighborhood characteristics also play a significant role in determining the CFR (15)(16)(17)(18)(19). The socioeconomic factors exert specific impacts on COVID-19 spread, including income, unemployment, inequality, poverty, total population, population density, human mobility, and medical resources (17,(19)(20)(21)(22).…”