Association of State Stay-at-Home Orders and State-Level African American Population With COVID-19 Case Rates.
Association of State Stay-at-Home Orders and State-Level African American Population With COVID-19 Case Rates.
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DOI：
10.1001/jamanetworkopen.2020.26010
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发表时间：
2020-10-01
影响因子：
13.8
通讯作者：
Sen B
中科院分区：
文献类型：
--
作者：
Padalabalanarayanan S;Hanumanthu VS;Sen B
居家令和非裔美国居民的州级比例与 2019 年冠状病毒 (COVID-19) 感染率相关吗？在这项横断面研究中，包括 2020 年 3 月至 5 月期间的 3023 项每日州级观察，多元回归模型的结果表明，居家令与累计 COVID-19 病例率的下降有关。非裔美国人人口较多的州的 COVID-19 病例率较高。这些发现强调了居家令对于应对 COVID-19 大流行的重要性以及解决感染率种族差异的必要性。这项横断面研究考察了州级居家令与 2019 年 3 月至 5 月非裔美国人中 2019 年冠状病毒病 (COVID-19) 病例率之间的关系。为了应对 2019 年冠状病毒病 (COVID-19) 的持续流行，州和地方官员需要有关旨在遏制疾病传播的政策有效性的信息，以及与该疾病相关风险增加相关的州特有特征（例如种族混合）。调查州实施的居家令 (SAHO) 和州内非裔美国人人口的比例是否与州级 COVID-19 病例相关。这项横断面研究使用了来自 COVID 追踪项目的关于 COVID-19 病例、检测和死亡人数的每日州级数据。使用了2020年3月1日至5月4日所有州（华盛顿州除外）以及哥伦比亚特区的数据。关键暴露变量是州级 SAHO（如果有，则为 1，否则为 0），以及州内非裔美国人的比例。主要结果是每日累积的 COVID-19 病例率。次要结果是随后的 COVID-19 死亡率，使用每个日期后 21 至 28 天的平均累积死亡率得出。估计多元回归模型。最终样本包括 3023 个汇总的州级和日级观测值。平均（SD）累积阳性病例率为每 100 万名州人口 103.186（200.067）例，平均（SD）累积检测率为每 100 000 名州人口 744.23（894.944）次检测，平均（SD）随后累积死亡率为每 100 名州人口 12.923（21.737）例死亡。 100 000 州人口。 SAHO与累积病例率（β = −1.166；95% CI，-1.484至-0.847；P < .001）和随后的死亡率（β = −0.204；95% CI，-0.294至-0.113；P < .001）呈负相关。估计分析表明，如果没有 SAHO，与完全建立 SAHO 相比，预期累积病例率将高出 200% 以上，死亡率将高出约 22%。非裔美国人人口比例较高与较高的发病率（β = 0.045；95% CI，0.014至0.077；P = .001）和死亡率（β = 0.068；95% CI，0.044至0.091；P < .001）相关。在这项横断面研究中，SAHO 与 COVID-19 病例率的降低有关。这些发现可能有助于决策者应对美国持续的 COVID-19 大流行。非裔美国人的比例与 COVID-19 病例率呈正相关，这一州级发现补充了现有生态研究的证据，该研究使用县级数据了解 COVID-19 感染率的种族差异，并强调了更好地理解和解决这些差异的紧迫性。
Are stay-at-home orders and state-level proportion of African American residents associated with coronavirus 2019 (COVID-19) infection rates? In this cross-sectional study including 3023 daily state-level observations from March to May 2020, results from multivariate regression models indicated that stay-at-home orders were associated with reductions in cumulative COVID-19 case rates. States with larger African American populations had higher COVID-19 case rates. These findings underscore the importance of stay-at-home orders in addressing the COVID-19 pandemic and the need to address racial disparities in rates of infection. This cross-sectional study examines the associations of state-level stay-at-home orders and proportion of African American population with coronavirus disease 2019 (COVID-19) case rates from March to May 2020. To cope with the continuing coronavirus disease 2019 (COVID-19) pandemic, state and local officials need information on the effectiveness of policies aimed at curbing disease spread, as well as state-specific characteristics, like the racial mix, associated with increased risks related to the disease. To investigate whether state-imposed stay-at-home orders (SAHOs) and the proportion of African American population in a state were associated with the state-level COVID-19 cases. This cross-sectional study used daily, state-level data on COVID-19 cases, tests, and fatalities from the COVID Tracking Project. Data from March 1 to May 4, 2020, for all states (except Washington state) as well as the District of Columbia were used. The key exposure variables were state-level SAHO (1 if in place, 0 otherwise), and proportion of state population who are African American. The primary outcome was daily cumulative COVID-19 case rates. A secondary outcome was subsequent COVID-19 fatality rates, derived using mean cumulative fatality rates 21 to 28 days after each date. Multivariate regression models were estimated. The final sample included 3023 pooled state- and day-level observations. The mean (SD) cumulative positive case rate was 103.186 (200.067) cases per 100 000 state population, the mean (SD) cumulative test rate was 744.23 (894.944) tests per 100 000 state population, and the mean (SD) subsequent cumulative fatality rate was 12.923 (21.737) deaths per 100 000 state population. There was a negative association of SAHOs with cumulative case rates (β = −1.166; 95% CI, −1.484 to −0.847; P < .001) and subsequent fatality rates (β = −0.204; 95% CI, −0.294 to −0.113; P < .001). Estimation analyses indicated that expected cumulative case rates would have been more than 200% higher and fatality rates approximately 22% higher if there were no SAHOs, as compared with SAHOs fully in place. A higher proportion of African American population was associated with higher case rates (β = 0.045; 95% CI, 0.014 to 0.077; P = .001) and fatality rates (β = 0.068; 95% CI, 0.044 to 0.091; P < .001). In this cross-sectional study, SAHOs were associated with reductions in COVID-19 case rates. These findings could help inform policy makers to address the continued COVID-19 pandemic in the US. The proportion of African American population was positively associated with COVID-19 case rates, and this state-level finding adds to evidence from existing ecological studies using county-level data on racial disparities in COVID-19 infection rates and underlines the urgency of better understanding and addressing these disparities.
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