Human participant protection and data
sharing
No humans participated in this study. The original data sources are
referenced in the section Methods and in Table 1
The Influence of Contextual Factors on the Initial Phases of the
COVID-19 Outbreak across U.S. Counties
Background . This study
examines the influence of contextual factors on the initial phases of
the COVID-19 outbreak across U.S. counties.
Methods . Contextual factors are simultaneously tested at the
county- and state-level with a multilevel linear model using full
maximum likelihood.
Results . The variation between states is substantial and
significant (ICC = 0.243, u 0 = 4.50E-04, p< 0.001). At the state-level, the cultural value of
collectivism is positively associated with the outbreak rate. At the
county-level, the racial and ethnic composition contributes to outbreak
differences, affecting Black/African and Asian Americans most. Counties
with a higher median age have a stronger outbreak, as do counties with
more people below the age of 18. Higher income, education, and personal
health are generally associated with a lower outbreak. Obesity is
negatively related to the outbreak, in agreement with the value
expectancy concepts of the health belief model. Smoking is also
negatively related, but only directionally informative. Air pollution is
another significant contributor to the outbreak, but population density
does not give statistical significance.
Conclusions . Because of a high variation in contextual factors,
policy makers need to target pandemic responses to the smallest
subdivision possible, so that countermeasures can be implemented
effectively.
Keywords: COVID-19; Novel coronavirus; Outbreak; Pandemic;
Regional differences.