■COVID-19大流行的不成比例的负担已经成为美国(美国)的一个主要问题,但尚未评估COVID-19病死率(CFR)与影响州健康结局的因素之间的关联.
■我们使用疾病控制和预防中心的COVID数据跟踪器计算了三种不同波的COVID-19CFR。美国的健康排名评估影响健康结果的因素,以确定州的健康排名。通过线性回归分析COVID-19CFR与州健康差异之间的关系。
■物理环境排名较高的州与第一波的CFR较低相关(β=0.06%,R2=0.170,P=0.003)。第二波CFR与临床护理之间存在矛盾的关联(β=-0.04%,R2=0.112,P=0.017)和整体健康排名(β=-0.03%,R2=0.096,P=0.029)。对于第三波,整体健康因素排名较高的州(β=0.01%,R2=0.179,P=0.002),社会经济因素(β=0.01%,R2=0.176,P=0.002),行为(β=0.01%,R2=0.204,P<0.001),和健康结果(β=0.01%,R2=0.163,P=0.004)与较低的CFR相关。COVID-19疫苗接种覆盖率也与州健康排名相关(至少一剂:β=-0.13%,R2=0.305,P<0.001;完全接种:β=-0.06%,R2=0.120,P=0.014)。
这些研究结果表明,有针对性的公共卫生干预措施和缓解策略解决健康差异对于改善COVID-19在美国的不公平结局至关重要。
UNASSIGNED: The disproportionate burden of COVID-19 pandemic has become a major concern in the United States (US), but the association between COVID-19
case-fatality rate (CFR) and factors influencing health outcomes at a state level has not been evaluated.
UNASSIGNED: We calculated COVID-19 CFR for three different waves using COVID Data Tracker from the Centers for Disease Control and Prevention. America\'s Health Rankings assesses the factors that influence health outcomes to determine state\'s health rankings. The association between COVID-19 CFR and state health disparities was analyzed by linear regression.
UNASSIGNED: States with better rankings of Physical Environment were associated with lower CFR for the 1st wave (β = 0.06%, R2 = 0.170, P = 0.003). There was a paradoxical association between the 2nd wave CFR and Clinical Care (β = -0.04%, R2 = 0.112, P = 0.017) and Overall health rankings (β = -0.03%, R2 = 0.096, P = 0.029). For the 3rd wave, states with better rankings of Overall health factors (β = 0.01%, R2 = 0.179, P = 0.002), Social & Economic Factors (β = 0.01%, R2 = 0.176, P = 0.002), Behaviors (β = 0.01%, R2 = 0.204, P < 0.001), and Health Outcomes (β = 0.01%, R2 = 0.163, P = 0.004) were associated with lower CFR. COVID-19 vaccination coverage was also associated with state health rankings (at least one dose: β = -0.13%, R2 = 0.305, P < 0.001; fully vaccinated: β = -0.06%, R2 = 0.120, P = 0.014).
UNASSIGNED: These findings suggested targeted public health interventions and mitigation strategies addressing health disparities are essential to improve inequitable outcomes of COVID-19 in the US.