Factors Definitions & Rationale Source
Calendar Month of the First Reported Case in the State Generated as the month when the first COVID-19 case was reported in the county. Based on the frequency distribution the following categories were created: January, February, March, April, May, and June to December. Month of first reported case has been used in previous studies. Earlier studies have included this variable due to its significant impact on the cumulative cases and deaths during the early phases of the pandemic.[@57425] 2020-2021 New York Times COVID-19 & Centers for Disease Control and Prevention Data[@57395]
Percent Positive for COVID-19* This factor was defined as the proportion of all COVID-19 tests performed that are positive.
Positivity rate = (positive tests)/(total tests) x 100%. Percent positivity rate is a proxy measure for extent of under/over testing and has been included to control for impact of geographic differences in testing rates.[@57424]
The COVID Tracking Project[@57415]
Social Distance Score It is defined as the average numerical score based on the following three metrics:
  • Change in average distance traveled compared to a pre-COVID-19 period.
  • Change in visitation to non-essential venues compared to a pre- COVID-19 period.
  • Probability that two devices were in the same place at the same time.
During the initial phases of the pandemic, social distances scores were found to be associated with lower COVID-19 mortality.[@57417]
Stringency Index Composite measure based on 9 response indicators, including school closures, workplace closures, testing policy and travel bans, rescaled to a value from 0 to 100 (100=strictest response). Stringency index has been previously used in ecological research on COVID-19 CFR.[@57414] Oxford COVID-19 Government Response Tracker[@57398]
Percent Adult Smokers Percentage of adults who are current smokers. CHRF Data[@57419]
Percent of Poor or Fair Health Percentage of adults reporting fair or poor health (age-adjusted).
Percent Low Birthweight Percentage of live births with low birthweight (< 2500 grams).
Teen Birth Rate Births per 1000 females ages 15-19
Percent Adult Obesity Percentage of the adult population (age 20 and older) who report a body mass index greater than or equal to 30 kg/m.2
Percent Excessive Drinking Percentage of adults reporting binge or heavy drinking.
Percent Flu Vaccine Percentage of fee-for-service Medicare enrollees who had an annual flu vaccination.
Percent with Annual Mammogram Percentage of female Medicare enrollees having an annual mammogram (age 65- 74).
Percent Physical Inactivity Percentage of adults age 20 and over reporting no leisure-time physical activity.
Income Inequality Ratio Ratio of household income at the 80th percentile to income at the 20th percentile.
Primary Care Physicians Rate (log)* Log of ratio of population to primary care physicians.
Preventable Hospitalization Rate (log)* Rate of hospital stays for ambulatory-care sensitive conditions per 100 000 Medicare enrollees.
Percent Educated at Some College Percentage of adults aged 25-44 with some post-secondary education.
Percent Unemployment Number of people aged 16 years and above unemployed and looking for work.
Percent Single Parent Percentage of children who live in single-parent households.
Social Association Rate Number of membership associations per 10 000 population.
Pollution Level: PM 2.5 Average daily density of fine particulate matter in micrograms per cubic meter (PM2.5).
Percent Severe Housing Problem Percentage of households with at least 1 of 4 housing problems: overcrowding, high housing costs, lack of kitchen facilities, or lack of plumbing facilities.
Percent Homeownership Percentage of occupied housing units that are owned.
Percent Uninsured Adult Percentage of adults under age 65 without health insurance.
Premature Age-adjusted Mortality Number of deaths among residents under age 75 per 100 000 population (age-adjusted).
Median Household Income (in Thousands) The income where half of households in a county earn more and half of households earn less.
Percent Over 65 Percentage of population aged 65 and older.
Percent Less Than 18 Percentage of population below 18 years of age.
Percent Black Percentage of population who are non-Hispanic African American.
Percent Native American Percentage of population who are American Indian or Alaska Native.
Percent Hispanic Percentage of population who are Hispanic.
Percent Female Percentage of population who are female.
Segregation Index: White/Non-White Index of dissimilarity where higher values indicate greater residential segregation between non-White and White county residents.
Percent Rural Percentage of population living in a rural area.
Percent Not Proficient in English Percentage of population who are not proficient in English.
Percent Diabetics Percentage of adults aged 20 and above with diagnosed diabetes.
Percent with Food Insecurity Percentage of population who lack adequate access to food.
Mental Health Provider Rate Mental health providers per 100 000 population.
Chlamydia Rate (Log) Chlamydia cases per 100 000 population
Percent SNAP Recipients Percentage of the population on food stamps or SNAP. 2019-2020 AHRF
Percent Public Transportation Percentage of the population using public transportation.
Percent of Workforce in Education, Health-care and Social Assistance Field Percentage of the population in the occupation of education/health-care/social assistance.
Percent of Workforce in Construction Percentage of the population who work in construction.
Percent of Workforce in Manufacturing Percentage of the population who are manufacturing workers.
Percent Poverty Percentage of the population below poverty level.
Hospital Bed Rates (log) Number of beds regularly maintained (set up and staffed for use) for inpatients.
Nursing Home Beds Number of nursing home unit beds in hospitals.
Long-term Care Beds (log) Number of long-term care beds in hospitals.
Population Resident population.
Population Density (log) Persons per 100 square mile area.