Pfizer Vaccines, Collegeville, Pennsylvania, USA.
Clin Infect Dis. 2021 Oct 5;73(7):e1814-e1821. doi: 10.1093/cid/ciaa1729.
The United States has been heavily impacted by the coronavirus disease 2019 (COVID-19) pandemic. Understanding microlevel patterns in US rates of COVID-19 can inform specific prevention strategies.
Using a negative binomial mixed-effects regression model, we evaluated the associations between a broad set of US county-level sociodemographic, economic, and health status-related characteristics and cumulative rates of laboratory-confirmed COVID-19 cases and deaths between 22 January 2020 and 31 August 2020.
Rates of COVID-19 cases and deaths were higher in US counties that were more urban or densely populated or that had more crowded housing, air pollution, women, persons aged 20-49 years, racial/ethnic minorities, residential housing segregation, income inequality, uninsured persons, diabetics, or mobility outside the home during the pandemic.
To our knowledge, this study provides results from the most comprehensive multivariable analysis of county-level predictors of rates of COVID-19 cases and deaths conducted to date. Our findings make clear that ensuring that COVID-19 preventive measures, including vaccines when available, reach vulnerable and minority communities and are distributed in a manner that meaningfully disrupts transmission (in addition to protecting those at highest risk of severe disease) will likely be critical to stem the pandemic.
美国深受 2019 年冠状病毒病（COVID-19）大流行的影响。了解美国 COVID-19 发病率的微观模式可以为特定的预防策略提供信息。
我们使用负二项式混合效应回归模型，评估了美国县级社会人口统计学、经济和与健康状况相关的一系列特征与 2020 年 1 月 22 日至 2020 年 8 月 31 日期间实验室确诊的 COVID-19 病例和死亡的累积率之间的关联。
在城市化程度较高或人口密度较大、住房拥挤、空气污染程度较高、女性、20-49 岁人群、少数民族、居住隔离、收入不平等、未参保人群、糖尿病患者或大流行期间居家外出活动较多的美国县，COVID-19 病例和死亡的发病率更高。
据我们所知，这是迄今为止对 COVID-19 病例和死亡的县级预测因素进行的最全面的多变量分析。我们的研究结果明确表明，确保 COVID-19 预防措施，包括可用疫苗，覆盖到弱势和少数族裔社区，并以能够有效阻断传播的方式（除了保护那些患重病风险最高的人）分发，这对于遏制大流行可能是至关重要的。
