Ahmed Rashid, Williamson Mark, Hamid Muhammad Akhter, Ashraf Naila
College of Nursing, University of Manitoba, Winnipeg, MB R3T 2N2, Canada.
School of Nursing and Professional Disciplines, University of North Dakota, Grand Forks, ND 58202, USA.
Healthcare (Basel). 2020 Sep 9;8(3):330. doi: 10.3390/healthcare8030330.
COVID-19 is a global pandemic with uncertain death rates. We examined county-level population morality rates (per 100,000) and case fatality rates by US region and rural-urban classification, while controlling for demographic, socioeconomic, and hospital variables. We found that population mortality rates and case fatality rates were significantly different across region, rural-urban classification, and their interaction. All significant comparisons had < 0.001. Northeast counties had the highest population mortality rates (27.4) but had similar case fatality rates (5.9%) compared to other regions except the Southeast, which had significantly lower rates (4.1%). Population mortality rates were highest in urban counties but conversely, case fatality rates were highest in rural counties. Death rates in the Northeast were driven by urban areas (e.g., small, East Coast states), while case fatality rates tended to be highest in the most rural counties for all regions, especially the Southwest. However, on further inspection, high case fatality rate percentages in the Southwest, as well as in overall US counties, were driven by a low case number. This makes it hard to distinguish genuinely higher mortality or an artifact of a small sample size. In summary, coronavirus deaths are not homogenous across the United States but instead vary by region and population and highlight the importance of fine-scale analysis.
新冠病毒肺炎（COVID-19）是一种死亡率不确定的全球大流行病。我们研究了美国各地区以及城乡分类下的县级人口死亡率（每10万人）和病死率，同时控制了人口统计学、社会经济和医院相关变量。我们发现，不同地区、城乡分类及其相互作用下的人口死亡率和病死率存在显著差异。所有显著差异的p值均<0.001。东北部各县的人口死亡率最高（27.4），但与除东南部以外的其他地区相比，病死率相似（5.9%），东南部的病死率显著较低（4.1%）。城市县的人口死亡率最高，但相反，农村县的病死率最高。东北部的死亡率是由城市地区（如东海岸的小州）推动的，而所有地区，尤其是西南部，农村县的病死率往往最高。然而，进一步检查发现，西南部以及美国各县总体病死率较高是由病例数少导致的。这使得很难区分是真正较高的死亡率还是小样本量造成的假象。总之，美国各地的新冠病毒死亡情况并不相同，而是因地区和人群而异，凸显了精细尺度分析的重要性。
