Determinants of COVID-19 Incidence and Mortality in the US: Spatial Analysis

The US continues to account for the highest proportion of the global coronavirus disease-2019 (COVID-19) cases and deaths. Amid the second wave, it is important to contextualize the spread and success of mitigation efforts. The objective of this study was to assess the ecological determinants (policy, health behaviors, socio-economic, physical environment, and clinical care) of COVID-19 incidence and mortality. Data from the New York Times COVID-19 repository (01/21/2020-10/27/2020), 2020 County Health Rankings, 2016 County Presidential Election Returns, and 2018-2019 Area Health Resource File were used. County-level logged incidence and mortality rate/million were modelled using Spatial Autoregressive Combined model and spatial. Counties with higher proportions of Republican voters, and racial minorities, those not proficient in English, and higher population density, pollution-particulate matter, residential segregation between non-Whites & Whites were associated with high incidence rates. Subsequently, counties with higher Republican voters, excessive drinkers, children in single-parent households, uninsured adults, racial minorities, females, and high population density, pollution-particulate matter, and residential segregation between non-Whites & Whites was associated with high COVID-19 mortality rates. The studys spatial models identified length of order, population density, income, and uninsurance rate, and race/ethnicity as some important determinants of the geographic disparities in COVID-19 incidence and mortality.