Abstract
BACKGROUND: Individual States of the USA have ethnic, economic, community health and education differences that influence the prevalence and outcomes of COVID-19 infection. We hypothesized that Statewide differences in the prevalence and fatality rates of COVID-19 infections are dependent on factors that may be determined by mathematical modeling. METHODS: Two separate statistical regression models were developed using COVID-19 case prevalence and case fatality rates functioning as dependent variables. We obtained data from the prevalence and deaths from COVID-19 cases for each state in the USA that was posted at 4 PM Central Standard Time on April 29, 2020 from the Worldometer website. Publicly available databases were utilized to obtain data for the independent variables in the model. RESULTS: Models are represented as follows: Statewide COVID-19 Prevalence Model Log (Statewide COVID_19 case prevalence) = 1.847* (100–250 individuals/mile2) +3.0025*(250+ individuals/mile2) + 1.021* (% African American population) +1.029* (% Hispanic American population +2.164 *(% adults aged 85+) Model results are shown in Table 1. Statewide COVID-19 Case Fatality Rate Model Log (Statewide COVID_19 case fatality rate) =2.194* (100–250 individuals/mile2) +2.758* (250+ individuals/mile2) +1.031* (% African American population) + 1.032* (% Hispanic American population) + 0.942 (% Native American population)+ 1.108 (% Asian American population) + 2.275 (% adults aged 85+) Model results are shown in Table 2. Table 1: COVID-19 Statewide Prevalence Model Table 2: COVID-19 Statewide Case Fatality Model CONCLUSION: Higher State population density (See Figure 1 and Figure 2) and higher State populations of elderly persons correspond to increased prevalence and case-fatality rates of COVID-19 infections. Statewide data also shows health disparities for COVID-19 infections in Hispanic Americans, African Americans, and Asian Americans. Paradoxically, States with larger populations of Native Americans who have known poor outcomes from COVID-19 infection demonstrate a decrease in case-fatality rates, suggesting a large effect of healthcare inequality in this population. Figure 1: ANOVA one-way analysis of the association between COVID-19 prevalence and population density Figure 2: ANOVA one-way analysis of the association between COVID-19 death prevalence and population density DISCLOSURES: Eli D. Ehrenpreis, MD, FACG, AGAF, E2Bio Consultants (Board Member, Chief Executive Officer)E2Bio Life Sciences (Shareholder, Chief Executive Officer)Level Ex, Inc. (Consultant)