ArticlePublic health2020
Variation in COVID-19 outbreaks at the US state and county levels.
Article in Public health, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers.
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Who cites it
12 citing papers in PubMed.
- Family and teachers lead the way: How different information sources about COVID-19 influenced children's well-being during the pandemic.Public health in practice (Oxford, England) · 2025Article
- Eliciting Opinions on Health Messaging During the COVID-19 Pandemic: Qualitative Survey Study.JMIR human factors · 2023Article
- Application of neighborhood-scale wastewater-based epidemiology in low COVID-19 incidence situations.The Science of the total environment · 2022Article
- The U.S. COVID-19 County Policy Database: a novel resource to support pandemic-related research.BMC public health · 2022Article
- The Utility of a Novel Definition of Health Care Regions in the United States in the Era of COVID-19: A Validation of the Pittsburgh Atlas Using Pneumonia Admissions.Annals of emergency medicine · 2022Article
- Disparities in demand for COVID-19 hospital care in the United States: Insights from a longitudinal hierarchical study.Health science reports · 2022Article
- A random forest model for forecasting regional COVID-19 cases utilizing reproduction number estimates and demographic data.Chaos, solitons, and fractals · 2022Article
- Risk perceptions and health behaviors as COVID-19 emerged in the United States: Results from a probability-based nationally representative sample.Journal of experimental psychology. Applied · 2021Article
- Age groups that sustain resurging COVID-19 epidemics in the United States.Science (New York, N.Y.) · 2021Article
- Contextual factors and the COVID-19 outbreak rate across U.S. counties in its initial phase.Health science reports · 2021Article
- The association of cultural and contextual factors with social contact avoidance during the COVID-19 pandemic.PloS one · 2021Article
- U.S. regional differences in physical distancing: Evaluating racial and socioeconomic divides during the COVID-19 pandemic.PloS one · 2021Article
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Authors and funding
2 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveThe COVID-19 pandemic poses an unprecedented threat to the health and economic prosperity of the world's population. Yet, because not all regions are affected equally, this research aims to understand whether the relative growth rate of the initial outbreak in early 2020 varied significantly between the US states and counties. STUDY
designBased on publicly available case data from across the USA, the initial outbreak is statistically modeled as an exponential curve.
methodsRegional differences are visually compared using geo maps and spaghetti lines. In addition, they are statistically analyzed as an unconditional model (one-way random effects analysis of variance estimated with HLM 7.03); the bias between state- and county-level models is evidenced with distribution tests and Bland-Altman plots (using SPSS 26).
resultsAt the state level, the outbreak rate follows a normal distribution with an average relative growth rate of 0.197 (doubling time 3.518 days). But there is a low degree of reliability between state-wide and county-specific data reported (Intraclass correlation coefficient ICC = 0.169, P < 0.001), with a bias of 0.070 (standard deviation 0.062) as shown with a Bland-Altman plot. Hence, there is a significant variation in the outbreak between the US states and counties.
conclusionsThe results emphasize the need for policy makers to look at the pandemic from the smallest population subdivision possible, so that countermeasures can be implemented, and critical resources provided effectively. Further research is needed to understand the reasons for these regional differences.
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