Risk factors for increased COVID-19 case-fatality in the United States: A county-level analysis during the first wave

PLoS One. 2021 Oct 14;16(10):e0258308. doi: 10.1371/journal.pone.0258308. eCollection 2021.


The ongoing COVID-19 pandemic is causing significant morbidity and mortality across the US. In this ecological study, we identified county-level variables associated with the COVID-19 case-fatality rate (CFR) using publicly available datasets and a negative binomial generalized linear model. Variables associated with decreased CFR included a greater number of hospitals per 10,000 people, banning religious gatherings, a higher percentage of people living in mobile homes, and a higher percentage of uninsured people. Variables associated with increased CFR included a higher percentage of the population over age 65, a higher percentage of Black or African Americans, a higher asthma prevalence, and a greater number of hospitals in a county. By identifying factors that are associated with COVID-19 CFR in US counties, we hope to help officials target public health interventions and healthcare resources to locations that are at increased risk of COVID-19 fatalities.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Age Factors
  • COVID-19 / mortality*
  • Cross-Sectional Studies
  • Female
  • Humans
  • Male
  • Models, Theoretical
  • Pandemics
  • Prognosis
  • Risk Factors
  • United States / epidemiology