A county-level susceptibility index and coronavirus disease 2019 mortality in the United States: A socioecological study

Sadiya S. Khan, Megan E. McCabe, Amy E. Krefman, Lucia Catherine Petito, Xiaoyun Yang, Kiarri N. Kershaw, Lindsay R Pool, Norrina B. Allen*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

As of June 2020, the United States (US) has experienced the highest number of deaths related to coronavirus disease 2019 (Covid-19) in the world, but significant geographic heterogeneity exists at the county-level. Therefore, we sought to classify counties in the United States across multiple domains utilizing a socioecological framework and examine the association between these county-level groups and Covid-19 mortality. We harmonized and linked county-level sociodemographic, health, and environmental metrics associated with increased susceptibility for Covid-19 mortality. Latent class analysis defined a county-level susceptibility index (CSI) based on these metrics (n=2701 counties). Next, we used linear regression models to estimate the associations of the CSI and Covid-19 deaths per capita and initial mortality doubling time (as of 6/2/20), adjusted for days since first Covid-19 case. We identified 4 groups classified by the CSI with distinct sociodemographic, health, and environmental profiles and widespread geographic dispersion. Covid-19 deaths per capita were significantly higher in the group consisting of rural, vulnerable counties (55.8 [95% CI 50.3-61.2] deaths per 100,000) compared with the group with diverse, urban counties (32.2 [27.3-37.0]) at similar points in the outbreak (76 days since first case). Our findings can inform equitable resource allocation for Covid-19 to allow targeted public health preparedness and response in vulnerable counties.

Original languageEnglish (US)
JournalUnknown Journal
DOIs
StatePublished - Jul 6 2020

Keywords

  • Communicable diseases
  • County-level health
  • Covid-19
  • Pandemic

ASJC Scopus subject areas

  • Medicine(all)

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