Identifying US Counties with High Cumulative COVID-19 Burden and Their Characteristics

Abstract

Identifying areas with high COVID-19 burden and their characteristics can help improve vaccine distribution and uptake, reduce burdens on health care systems, and allow for better allocation of public health intervention resources. Synthesizing data from various government and nonprofit institutions of 3,142 United States (US) counties as of 12/21/2020, we studied county-level characteristics that are associated with cumulative case and death rates using regression analyses. Our results showed counties that are more rural, counties with more White/non-White segregation, and counties with higher percentages of people of color, in poverty, with no high school diploma, and with medical comorbidities such as diabetes and hypertension are associated with higher cumulative COVID-19 case and death rates. We identify the hardest hit counties in US using model-estimated case and death rates, which provide more reliable estimates of cumulative COVID-19 burdens than those using raw observed county-specific rates. Identification of counties with high disease burdens and understanding the characteristics of these counties can help inform policies to improve vaccine distribution, deployment and uptake, prevent overwhelming health care systems, and enhance testing access, personal protection equipment access, and other resource allocation efforts, all of which can help save more lives for vulnerable communities.Significance statementWe found counties that are more rural, counties with more White/non-White segregation, and counties with higher percentages of people of color, in poverty, with no high school diploma, and with medical comorbidities such as diabetes and hypertension are associated with higher cumulative COVID-19 case and death rates. We also identified individual counties with high cumulative COVID-19 burden. Identification of counties with high disease burdens and understanding the characteristics of these counties can help inform policies to improve vaccine distribution, deployment and uptake, prevent overwhelming health care systems, and enhance testing access, personal protection equipment access, and other resource allocation efforts, all of which can help save more lives for vulnerable communities.

Actual Racial/Ethnic Disparities in COVID-19 Mortality for the Non-Hispanic Black Compared to Non-Hispanic White Population in 35 US States and Their Association with Structural Racism

“…Although six other studies [42][43][44][45][46][47] found a relationship between measures of structural racism and racial disparities in COVID-19 mortality at the county level, this paper documents such a relationship at the state level. This finding is important because it is at the state level that most power resides to enact or refine laws related to public health and safety that could directly impact these observed disparities [48].…”

“…With national age-adjusted death rates revealing an even more profound racial disparity in COVID-19 mortality, it is even more crucial to determine the reasons for these disparities. Although many papers have suggested that structural racism is a critical factor in explaining racial disparities in COVID-19 mortality, we are aware of only six that have demonstrated this relationship empirically by explicitly measuring structural racism [42][43][44][45][46][47]. Tan et al [42] examined the relationship between four measures of structural racism (residential segregation and differences in incarceration rates, economic status, and employment status) and county-level COVID-19 death rates, finding that the degree of residential segregation was significantly related to higher overall death rates.…”

“…Five other studies examined the relationship between measures of structural racism and overall county-level COVID-19 mortality [43][44][45][46][47]. The measures used in these studies were the proportion of individuals living in "Black-concentrated" Census tracts [43], implicit and explicit racial attitudes [44], and racial residential segregation [45][46][47]. Like Tan et al [42], none of these studies modeled race-specific mortality rates.…”

Census Tract Patterns and Contextual Social Determinants of Health Associated With COVID-19 in a Hispanic Population From South Texas: A Spatiotemporal Perspective

“…In the United States, it also has disproportionately affected minority and underserved populations, where COVID-19 infection and fatality rates are significantly higher among African American and Hispanic populations [1][2][3]. Previous studies have shown various social determinants of health (SDOH) that may explain the disparity in COVID-19 incidence and mortality in ethnic and racial minorities [1,4,5].…”

“…The geographical scale of the US county often lacks granularity to reveal the local spatial pattern and detect local hot spots (ie, areas with excessive infection rates). Moreover, the high variability of SDOH within a county population was not able to accurately examine the impact of SDOH on COVID-19 disparities in populations [5]. Studies that investigate the SDOH and COVID-19 incidence and mortality at a geographical scale smaller than the US county are limited [7,8].…”