Chiang Yunyu Amy, Pacca Lucia, Vable Anusha, Carton Thomas, Pletcher Mark J, Hamad Rita
University of California San Francisco, San Francisco, CA, USA.
Louisiana Public Health Institute, New Orleans, LA, USA.
SSM Popul Health. 2024 Dec 10;29:101734. doi: 10.1016/j.ssmph.2024.101734. eCollection 2025 Mar.
It is increasingly recognized that policies played a role in mitigating or exacerbating health inequities during the COVID-19 pandemic. While US counties were particularly active in policymaking, limited work has characterized geographic and temporal variation in pandemic-era policymaking at the local level, a prerequisite for later studies examining the health effects of these policies. This paper fills this gap by characterizing county-level COVID-19-related policy trajectories over time using a novel national policy database and innovative methods.
Data came from the US COVID-19 County Policy (UCCP) Database, including 309 counties in 50 states plus Washington DC during January 2020 to December 2021. We examined measures of overall policy comprehensiveness, as well as three domains including containment and closure, economic response, and public health. We applied sequence analysis to characterize county-level trajectories overall and within each policy domain, and cluster analysis to group similar trajectories.
There was wide variation in policymaking, with nearly half of counties demonstrating consistently comprehensive policymaking, about 15-20% with consistently low comprehensiveness, and the remainder exhibiting intermittent comprehensiveness. Economic policies were less comprehensive than containment/closure and public health policies. There was also substantial variation within and across states, and associations with county characteristics.
This study is among the first to document substantial geographic and temporal variation in a variety of US county-level COVID-19-related policies, which likely contributed to health disparities during and after the pandemic. Future work should evaluate how these different policy trajectories differentially affected health and social outcomes.
人们越来越认识到，政策在缓解或加剧新冠疫情期间的健康不平等方面发挥了作用。虽然美国各县在政策制定方面表现得尤为积极，但在地方层面，关于疫情时期政策制定的地理和时间变化的研究有限，而这是后续研究这些政策对健康影响的前提条件。本文通过使用一个全新的国家政策数据库和创新方法，描述县级新冠疫情相关政策随时间的变化轨迹，填补了这一空白。
数据来自美国新冠疫情县级政策（UCCP）数据库，涵盖2020年1月至2021年12月期间50个州加华盛顿特区的309个县。我们研究了总体政策全面性的衡量指标，以及包括防控与封锁、经济应对和公共卫生在内的三个领域。我们应用序列分析来描述县级总体轨迹以及每个政策领域内的轨迹，并应用聚类分析对相似轨迹进行分组。
政策制定存在很大差异，近一半的县始终表现出全面的政策制定，约15%-20%的县政策全面性始终较低，其余的县则表现出间歇性的全面性。经济政策不如防控/封锁和公共卫生政策全面。州内和州际也存在很大差异，且与县的特征有关联。
本研究是最早记录美国县级各类新冠疫情相关政策在地理和时间上存在显著差异的研究之一，这些差异可能导致了疫情期间及之后的健康差距。未来的工作应评估这些不同的政策轨迹如何对健康和社会结果产生不同影响。
