In the USA, there has been substantial variation in COVID-19 outcomes across states. In exploring the reasons for this variation, the authors used correlations and multiple regression to assess the independent contributions of socioeconomic status, income inequality, race, behavioral responses, policy mandates, and support for political candidates to SARS-CoV-2 infection rates, COVID-19 deaths, and educational and employment outcomes. Their analysis showed that wide variations in pre-pandemic population characteristics between states were strongly associated with COVID-19 outcomes. COVID-19 mortality was highly correlated with poverty rate (with a one SD increase from the US mean associated with a 23.3% [95% uncertainty interval 14.8–32.5] increase in the cumulative death rate) and degree of income inequality (with a one SD increase associated with an 11.6% [2.7–21.3] increase in the cumulative death rate). COVID-19 mortality was also negatively correlated with mean years of education, with a one SD increase in mean years of education associated with a 14·3% (7.1–20.9) decrease in the cumulative death rate. Race and ethnicity were associated with these three pre-COVID-19 state characteristics and with COVID-19 outcomes for a host of structural, historical, and policy reasons.

“If the USA is serious about preventing terrible outcomes the next time, improvements in surveillance and countermeasures will be crucial. However, this analysis suggests that these tools will not live up to their potential without social and economic policies that narrow inequality, political leadership that respects scientific evidence, investments in public health infrastructure that build resilience and connection, and a focus on pursuing health and other social goals together. It is a challenging task, but its difficulty does not make it any less necessary.”1

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References

  1. Lurie, N., & Sharfstein, J. M. (2023). State-to-state differences in US COVID-19 outcomes: searching for explanations. The Lancet, 401(10385), 1314–1315. https://doi.org/10.1016/s0140-6736(23)00726-2

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