Background Geographic heterogeneity in COVID-19 outcomes in the United States is well-documented and has been linked with factors at the county level, including sociodemographic and health factors. Whether an integrated measure of place-based risk can classify counties at high risk for COVID-19 outcomes is not known. Methods We conducted an ecological nationwide analysis of 2,701 US counties from 1/21/20 to 2/17/21. County-level characteristics across multiple domains, including demographic, socioeconomic, healthcare access, physical environment, and health factor prevalence were harmonized and linked from a variety of sources. We performed latent class analysis to identify distinct groups of counties based on multiple sociodemographic, health, and environmental domains and examined the association with COVID-19 cases and deaths per 100,000 population. Results Analysis of 25.9 million COVID-19 cases and 481,238 COVID-19 deaths revealed large between-county differences with widespread geographic dispersion, with the gap in cumulative cases and death rates between counties in the 90 th and 10 th percentile of 6,581 and 291 per 100,000, respectively. Counties from rural areas tended to cluster together compared with urban areas and were further stratified by social determinants of health factors that reflected high and low social vulnerability. Highest rates of cumulative COVID-19 cases (9,557 [2,520]) and deaths (210 [97]) per 100,000 occurred in the cluster comprised of rural disadvantaged counties. Conclusions County-level COVID-19 cases and deaths had substantial disparities with heterogeneous geographic spread across the US. The approach to county-level risk characterization used in this study has the potential to provide novel insights into communicable disease patterns and disparities at the local level. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-12469-y.
【저자키워드】 COVID-19, pandemic, communicable diseases, County-level health, 【초록키워드】 risk, Local, outcome, heterogeneity, Spread, Prevalence, Health, Characteristics, healthcare, Factors, death, Cluster, group, communicable, disease, association, Analysis, high risk, death rate, Factor, supplementary material, domains, COVID-19 case, domain, heterogeneous, cumulative, Sociodemographic, widespread, approach, physical, Result, identify, performed, occurred, examined, the United State, conducted, reflected, variety, ecological, stratified, Geographic, latent class, social determinant, with COVID-19, 【제목키워드】 risk, outcome, group,