Spatial Disparities in Coronavirus Incidence and Mortality in the United States: An Ecological Analysis as of May 2020

Charlie H Zhang, Gary G Schwartz, Charlie H Zhang, Gary G Schwartz

Abstract

Purpose: This ecological analysis investigates the spatial patterns of the COVID-19 epidemic in the United States in relation to socioeconomic variables that characterize US counties.

Methods: Data on confirmed cases and deaths from COVID-19 for 2,814 US counties were obtained from Johns Hopkins University. We used Geographic Information Systems (GIS) to map the spatial aspects of this pandemic and investigate the disparities between metropolitan and nonmetropolitan communities. Multiple regression models were used to explore the contextual risk factors of infections and death across US counties. We included population density, percent of population aged 65+, percent population in poverty, percent minority population, and percent of the uninsured as independent variables. A state-level measure of the percent of the population that has been tested for COVID-19 was used to control for the impact of testing.

Findings: The impact of COVID-19 in the United States has been extremely uneven. Although densely populated large cities and their surrounding metropolitan areas are hotspots of the pandemic, it is counterintuitive that incidence and mortality rates in some small cities and nonmetropolitan counties approximate those in epicenters such as New York City. Regression analyses support the hypotheses of positive correlations between COVID-19 incidence and mortality rates and socioeconomic factors including population density, proportions of elderly residents, poverty, and percent population tested.

Conclusions: Knowledge about the spatial aspects of the COVID-19 epidemic and its socioeconomic correlates can inform first responders and government efforts. Directives for social distancing and to "shelter-in-place" should continue to stem the spread of COVID-19.

Keywords: COVID-19; metropolitan areas; pandemic; rural or nonmetropolitan; spatial disparities.

© 2020 The Authors. The Journal of Rural Health Published by Wiley Periodicals, Inc. on behalf of National Rural Health Association.

Figures

Figure 1
Figure 1
Average Incidence Rates of Confirmed Cases and Deaths from COVID‐19 Pandemic for US Counties Classified by USDA Urban‐Rural Locale Codes (2013).
Figure 2
Figure 2
Average Incidence and Mortality Rates in Urban, Suburban, and Rural Counties in the United States.
Figure 3
Figure 3
Map of Confirmed Cases of COVID‐19 (per 100,000 population) in the Conterminous 48 States.
Figure 4
Figure 4
Map of Deaths from COVID‐19 (per 100,000 population) in the Conterminous 48 States.

References

    1. Mayo Clinic . Coronavirus disease 2019 (COVID‐19)—Symptoms and causes 2020. Available at: . Accessed April 14, 2020.
    1. Holshue ML, DeBolt C, Lindquist S, et al. First case of 2019 novel coronavirus in the United States. N Engl J Med. 2020;382:929‐936.
    1. Lewis D. Is the coronavirus airborne? Experts can't agree. Nature. 2020;580:175.
    1. Bourouiba L. Turbulent gas clouds and respiratory pathogen emissions: potential implications for reducing transmission of COVID‐19. JAMA. 2020;323(18):1837‐1838.
    1. Gautret P, Lagier J‐C, Parola P, et al. Hydroxychloroquine and azithromycin as a treatment of COVID‐19: results of an open‐label non‐randomized clinical trial. Int J Antimicrob Agents. 2020;105949 10.1016/j.ijantimicag.2020.105949
    1. Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID‐19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. JAMA. 2020;323(13):1239‐1242.
    1. Peeri NC, Shrestha N, Rahman MS, et al. The SARS, MERS and novel coronavirus (COVID‐19) epidemics, the newest and biggest global health threats: what lessons have we learned? Int J Epidemiol. 2020;dyaa033 10.1093/ije/dyaa033
    1. Rothan HA, Byrareddy SN. The epidemiology and pathogenesis of coronavirus disease (COVID‐19) outbreak. J Autoimmun. 2020;109:102433.
    1. Wang W, Tang J, Wei F. Updated understanding of the outbreak of 2019 novel coronavirus (2019‐nCoV) in Wuhan, China. J Med Virol. 2020;92(4):441‐447.
    1. Lighter J, Phillips M, Hochman S, et al. Obesity in patients younger than 60 years is a risk factor for Covid‐19 hospital admission. Clin Infect Dis. 2020;ciaa415 10.1093/cid/ciaa415
    1. Wadhera RK, Wadhera P, Gaba P, et al. Variation in COVID‐19 hospitalizations and deaths across New York City boroughs. JAMA. 2020. 10.1001/jama.2020.7197
    1. Newkirk VR II. The coronavirus's unique threat to the south: more young people in the south seem to be dying from covid‐19. Why? Atlantic. 2020. Available at:
    1. Krout JA. Rural ageing. GIA— Grantmakers in aging Available at . Accessed April 8, 2020.
    1. Baernholdt M, Yan G, Hinton I, Rose K, Mattos M. Quality of life in rural and urban adults 65 years and older: findings from the National Health and Nutrition Examination survey. J Rural Health. 2012;28(4):339‐347.
    1. Lakhani A. Introducing the percent, number, availability, and capacity [PNAC] spatial approach to identify priority rural areas requiring targeted health support in light of COVID‐19: a commentary and application. J Rural Health. 2020. 10.1111/jrh.12436
    1. Befort CA, Nazir N, Perri MG. Prevalence of obesity among adults from rural and urban areas of the United States: findings from NHANES (2005–2008). J Rural Health. 2012;28(4):392‐397.
    1. Monnat S. Why coronavirus could hit rural areas harder. Lerner Center for Public Health Promotion, Syracuse University; 2020. Available at: . Accessed April 9, 2020.
    1. Ranscombe P. Rural areas at risk during COVID‐19 pandemic. Lancet Infect Dis. 2020;20:545.
    1. Kamel Boulos MN, Geraghty EM. Geographical tracking and mapping of coronavirus disease COVID‐19/severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) epidemic and associated events around the world: how 21st century GIS technologies are supporting the global fight against outbreaks and epidemics. Int J Health Geogr. 2020;19(1):8.
    1. Dong E, Du H, Gardner L. An interactive web‐based dashboard to track COVID‐19 in real time. Lancet Infect Dis. 2020;20(5):533‐534.
    1. Zhou C, Su F, Pei T, et al. COVID‐19: challenges to GIS with big data. Geogr Sustain. 2020;1(1):77‐87.
    1. Xu B, Gutierrez B, Mekaru S, et al. Epidemiological data from the COVID‐19 outbreak, real‐time case information. Sci Data. 2020;7(1):106.
    1. Lipsitch M, Swerdlow DL, Finelli L. Defining the epidemiology of Covid‐19—studies needed. N Engl J Med. 2020;382:1194‐1196.
    1. CDC COVID‐19 Response Team . Geographic differences in covid‐19 cases, deaths, and incidence—United States, February 12–April 7, 2020. MMWR Morb Mortal Wkly Rep. 2020;69:465‐471.
    1. Petrilli CM, Jones SA, Yang J, et al. Factors associated with hospitalization and critical illness among 4,103 patients with COVID‐19 disease in New York City. medRxiv. 10.1101/2020.04.08.20057794
    1. Chen R, Liang W, Jiang M, et al. Risk factors of fatal outcome in hospitalized subjects with coronavirus disease 2019 from a nationwide analysis in China. Chest. 2020. 10.1016/j.chest.2020.04.010
    1. Wu C, Chen X, Cai Y, et al. Risk factors associated with acute respiratory distress syndrome and death in patients with Coronavirus disease 2019 pneumonia in Wuhan, China. JAMA Intern Med. 2020. 10.1001/jamainternmed.2020.0994
    1. Martin SL, Kirkner GJ, Mayo K, et al. Urban, rural, and regional variations in physical activity. J Rural Health. 2005;21(3):239‐244.
    1. Moss JL, Liu B, Feuer EJ. Urban/rural differences in breast and cervical cancer incidence: the mediating roles of socioeconomic status and provider density. Women's Health Issues. 2017;27(6):683‐691.
    1. Lawrence E, Hummer RA, Harris KM. The cardiovascular health of young adults: disparities along the urban‐rural continuum. Ann Am Acad Pol Soc Sci. 2017;672(1):257‐281.
    1. Srinivasan S, Moser RP, Willis G, et al. Small is essential: importance of subpopulation research in cancer control. Am J Public Health. 2015;105(Suppl 3):S371‐S373.
    1. Florida R. The geography of coronavirus. Citylab. 2020. Available at: . Accessed April 9, 2020.
    1. Emanuel EJ, Persad G, Upshur R, et al. Fair allocation of scarce medical resources in the time of Covid‐19. N Engl J Med. 2020;382:2049‐2055.
    1. Benz JK, Espinosa O, Welsh V, Fontes A. Awareness of racial and ethnic health disparities has improved only modestly over a decade. Health Aff. 2011;30(10):1860‐1867.
    1. James CV, Moonesinghe R, Wilson‐Frederick SM, Hall JE, Penman‐Aguilar A, Bouye K. Racial/ethnic health disparities among rural adults—United States, 2012–2015. MMWR Surv Summaries. 2017;66(23):1‐9.
    1. Jackson CS, Oman M, Patel AM, Vega KJ. Health disparities in colorectal cancer among racial and ethnic minorities in the United States. J Gastrointest Oncol. 2016;7(Suppl 1):S32‐S43.
    1. National Academies of Sciences E, Medicine . Communities in Action: Pathways to Health Equity. Washington, D.C.: National Academies Press; 2017.
    1. Souch JM, Cossman JS. A commentary on rural‐urban disparities in covid‐19 testing rates per 100,000 and risk factors. J Rural Health. 2020. 10.1111/jrh.12450
    1. Willis H, Williams V. A funeral is thought to have sparked a covid‐19 outbreak in Albany, Ga.—and led to many more funerals. The Washington Post, 2020. Available at: . Accessed 12 April 2020.
    1. McLaughlin DK, Jensen L. Poverty among older Americans: the plight of nonmetropolitan elders. J Gerontol. 1993;48(2):S44‐S54.
    1. Nagata JM. Rapid scale‐up of Telehealth during the COVID‐19 pandemic and implications for subspecialty care in rural areas. J Rural Health. 2020. 10.1111/jrh.12433
    1. Prusaczyk B. Strategies for disseminating and implementing COVID‐19 public health prevention practices in rural areas. J Rural Health. 2020. 10.1111/jrh.12432
    1. Adunlin G, Murphy PZ, Manis M. COVID‐19: how can rural community pharmacies respond to the outbreak? J Rural Health. 2020. 10.1111/jrh.12439
    1. Laurencin CT, McClinton A. The covid‐19 pandemic: a call to action to identify and address racial and ethnic disparities. J Racial Ethn Health Disparities. 2020;7(3):398‐402.

Source: PubMed

Sponsoren und Mitarbeiter

Krankheiten

Drogeninterventionen

3
Abonnieren