Social Disadvantage, Politics, and SARS-CoV-2 Trends: A County-Level Analysis of United States Data

  1. Ahmad Mourad
  2. Nicholas A. Turner
  3. Arthur W. Baker
  4. Nwora Lance Okeke
  5. Shanti Narayanasamy
  6. Robert Rolfe
  7. John J. Engemann
  8. Gary M. Cox
  9. Jason E. Stout
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Abstract

Background

Understanding the epidemiology of SARS-CoV-2 is essential for public health control efforts. Social, demographic, and political characteristics at the US county level might be associated with the trajectories of SARS-CoV-2 case incidence.

Objective

To understand how underlying social, demographic, and political characteristics at the US county level might be associated with the trajectories of SARS-CoV-2 case incidence.

Design

Retrospective analysis of the trajectory of reported SARS-CoV-2 case counts at the US county level during June 1, 2020 – June 30,2020 and social, demographic, and political characteristics of the county.

Setting

United States.

Participants

Reported SARS-CoV-2 cases.

Exposures

Metropolitan designation, Social Deprivation Index (SDI), 2016 Republican Presidential Candidate Victory.

Main Outcomes and Measures

SARS-CoV-2 case incidence.

Results

1023/3142 US counties were included in the analysis. 678 (66.3%) had increasing SARS-CoV-2 case counts between June 1 – June 30, 2020. In univariate analysis, counties with increasing case counts had a significantly higher SDI (median 48, IQR 24 – 72) than counties with non-increasing case counts (median 40, IQR 19 – 66; p=0.009). In the multivariable model, metropolitan areas of 250,000 – 1 million population, higher percentage of Black residents and a 10-point or greater Republican victory were independently associated with increasing case counts.

Limitations

The data examines county-level voting patterns and does not account for individual voting behavior, subjecting this work to the potential for ecologic fallacy.

Conclusion

Increasing case counts of SARS-CoV-2 in the US are likely driven by a combination of social disadvantage, social networks, and behavioral factors. Addressing social disadvantage and differential belief systems that may correspond with political alignment will be essential for pandemic control.

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