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Understanding the Differences in COVID-19 Case Fatality Rates Observed Across Alabama Counties.

Arash Velayati1, Devesh Dahale, Arielle Dahlin

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This summary is machine-generated.

County COVID-19 fatality rates vary significantly, driven by social determinants of health like comorbidities, not testing or incidence. These findings aid targeted public health and vaccination strategies.

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Area of Science:

  • Epidemiology
  • Public Health
  • Health Disparities

Background:

  • COVID-19 case fatality rates (CFR) exhibit significant county-level variation.
  • Understanding these disparities is crucial for effective public health interventions.
  • Social determinants of health (SDOH) may play a role in CFR variations.

Purpose of the Study:

  • To analyze county-level variation in COVID-19 CFR in Alabama.
  • To identify factors associated with high and low CFR across counties.
  • To assess the utility of funnel charts in identifying outlier CFRs.

Main Methods:

  • Utilized publicly available COVID-19 incidence and CFR data for all 67 Alabama counties.
  • Mapped CFR data with county-level health disparities and SDOH.
  • Employed a funnel chart adaptation of the Shewhart p-chart to compare CFRs.

Main Results:

  • Significant differences in CFRs were observed across counties, not explained by testing or incidence rates.
  • Counties with higher CFRs showed a greater prevalence of comorbidities and vulnerabilities.
  • No differences in access to acute care were found between high and low CFR counties.
  • Funnel charts effectively identified counties with unexpected high and low CFRs.

Conclusions:

  • SDOH, particularly comorbidities and vulnerabilities, are strongly associated with county-level COVID-19 CFR variations.
  • Testing and incidence rates do not adequately explain observed CFR disparities.
  • Findings can inform public health strategies, including vaccination, especially in demographically similar southern states.