Accepted for/Published in: JMIR Public Health and Surveillance
Date Submitted: Jun 22, 2020
Date Accepted: Jan 20, 2021
Date Submitted to PubMed: Mar 19, 2021
The influence of social distancing on COVID-19 mortality in US counties: Cross-Sectional Study
ABSTRACT
Background:
Prior literature examining the impact of social distancing on US COVID-19 mortality mainly focuses on this relationship at the state level without accounting for nursing home COVID-19 deaths. This approach may obscure differences in social distancing behaviors by county in addition to the actual effectiveness of social distancing in preventing COVID-19 deaths.
Objective:
To determine the influence of county level social distancing behavior on total COVID-19 deaths for counties throughout the US over the timespan that stay at home orders were implemented in most US states (March 2020-May 2020).
Methods:
Using social distancing data from tracked mobile phones in all US counties, we estimated the relationship between social distancing (average % of mobile phones leaving home between March 2020-May 2020) and total COVID-19 deaths (when the state a county is in first started enacting social distancing measures and up to May 31st, 2020) with a mixed-effects negative binomial model while accounting for nursing home COVID-19 deaths as well as social distancing and COVID-19 related factors (days between when the first confirmed case was reported and May 31st, 2020, population density, social vulnerability, and hospital resource availability). Results from the mixed-effects negative binomial model were then used to generate marginal effects at the mean which allowed for the separation of the influence of social distancing on COVID-19 deaths from other covariates while calculating total COVID-19 deaths/100,000 people.
Results:
Average mobile phone use between March 2020-May 2020, the social distancing variable in the study, was significantly associated with total COVID-19 deaths (P < .001). We observed that a 1% increase in average mobile phone use between March 2020-May 2020 led to an increase in total COVID-19 deaths by 6% (Incidence rate ratio (IRR): 1.06, 95% Confidence Interval (CI): 1.02, 1.10). Additionally, average mobile phone use values of 25-50% during these three months corresponded with 34.89 total COVID-19 deaths/100,000 people-155.43 total COVID-19 deaths/100,000 people.
Conclusions:
As stay-at-home orders have been lifted in many US states, continued adherence to other social distancing measures such as avoiding large gatherings and maintaining physical distance in public are key to preventing additional COVID-19 deaths in counties across the country. Clinical Trial: Not applicable
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