Dataset Information

State-level variation of initial COVID-19 dynamics in the United States.

ABSTRACT: During an epidemic, metrics such as R0, doubling time, and case fatality rates are important in understanding and predicting the course of an epidemic. However, if collected over country or regional scales, these metrics hide important smaller-scale, local dynamics. We examine how commonly used epidemiological metrics differ for each individual state within the United States during the initial COVID-19 outbreak. We found that the detected case number and trajectory of early detected cases differ considerably between states. We then test for correlations with testing protocols, interventions and population characteristics. We find that epidemic dynamics were most strongly associated with non-pharmaceutical government actions during the early phase of the epidemic. In particular, early social distancing restrictions, particularly on restaurant operations, was correlated with increased doubling times. Interestingly, we also found that states with little tolerance for deviance from enforced rules saw faster early epidemic growth. Together with other correlates such as population density, our results highlight the different factors involved in the heterogeneity in the early spread of COVID-19 throughout the United States. Although individual states are clearly not independent, they can serve as small, natural experiments in how different demographic patterns and government responses can impact the course of an epidemic.

SUBMITTER: White ER

PROVIDER: S-EPMC7553297 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Publications

State-level variation of initial COVID-19 dynamics in the United States.

White Easton R ER Hébert-Dufresne Laurent L

PloS one 20201013 10

During an epidemic, metrics such as R0, doubling time, and case fatality rates are important in understanding and predicting the course of an epidemic. However, if collected over country or regional scales, these metrics hide important smaller-scale, local dynamics. We examine how commonly used epidemiological metrics differ for each individual state within the United States during the initial COVID-19 outbreak. We found that the detected case number and trajectory of early detected cases differ ...[more]

PMID: 33048967

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Project description:ImportanceNeuraxial labor analgesia is recognized as the most effective method of providing pain relief during labor. Little is known about variation in the rates of neuraxial analgesia across US states. Identifying the presence and extent of variation may provide insights into practice variation and may indicate where access to neuraxial analgesia is inadequate.ObjectiveTo test the hypothesis that variation exists in neuraxial labor analgesia use among US states.Design, setting, and participantsRetrospective, population-based, cross-sectional analysis using US birth certificate data. Participants were 2?625?950 women who underwent labor in 2015.Main outcomes and measuresState-specific prevalence of neuraxial analgesia per 100 women who underwent labor and variability in neuraxial analgesia use among states, assessed using multilevel multivariable regression modeling with the median odds ratio and the intraclass correlation coefficient to evaluate variation by state.ResultsIn the study population of 2?625?950 women, 0.1% (n?=?2010) were younger than 15 years, 7.0% (n?=?183 546) were between the ages of 15 and 19 years, 23.6% (n?=?620 118) were between the ages of 20 and 24 years, 29.6% (n?=?777 957) were between the ages of 25 and 29 years, 26.0% (n?=?683 656) were between the ages of 30 and 34 years, 11.4% (n?=?298 237) were between the ages of 35 and 39 years, 2.2% (n?=?57 130) were between the ages of 40 and 44 years, and 0.1% (n?=?3296) were between the ages of 45 and 54 years. More than 90% were privately insured or insured with Medicaid. Neuraxial analgesia was used by 73.1% (n?=?1?920?368) of women. After adjustment for antepartum, obstetric, and intrapartum factors, Maine had the lowest neuraxial analgesia prevalence (36.6%; 95% CI, 33.2%-40.1%) and Nevada the highest (80.1%; 95% CI, 78.3%-81.7%). The adjusted median odds ratio was 1.5 (95% CI, 1.4-1.6), and the intraclass correlation coefficient was 5.4% (95% CI, 4.0%-7.9%).Conclusions and relevanceResults of this study suggest that a small portion of the overall variation in neuraxial analgesia use is explained by US states. Unmeasured patient-level and hospital-level factors likely account for a large portion of the variation between states. Efforts should be made to understand what the main reasons are for this variation and whether the variation influences maternal or perinatal outcomes.

Dataset Information

State-level variation of initial COVID-19 dynamics in the United States.

Publications

State-level variation of initial COVID-19 dynamics in the United States.

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