Rates of Smoking and Social Associations Predict PA County COVID Case Mortality

Two weeks ago I looked at the correlation between COVID case mortality and Trump's % of the vote in 2020 for Pennsylvania counties and six sub measures used to determine County Health Rankings.  The measure that was most strongly associated with COVID case mortality was the health behavior z-score (a higher z score is worse) accounting for 6.9% of the variability.  Health behaviors was even more strongly associated with Trump's % of the vote as shown in the above graph accounting for 34.4% of the variability.  This association would be even stronger if Philadelphia were excluded.  This post will focus on the individual statistics used to determine the sub measures and their association with COVID Case Mortality.  The mortality rates occur on top of the the other health issues confronting each county.

The above graph shows the strongest univariate association for the number of social membership associations per 100,000 and COVID Case mortality.  This relationship accounts for 20.4% of the variability.  This measure is not a component of the health behaviors sub measure.  It is a component of the social and economic measure.  The number of social associations is weakly correlated with health behaviors, accounting for 4.9% of the variability.

The next strongest variable associated with COVID Case Mortality is the average number of mentally unhealthy days (as reported to the Behavioral Risk Factor Surveillance System).  This measure accounted for 18.6% of the variability.  This measure is a component of the quality of life sub measure.

 

The percentage of smokers in the county is positively associated with the COVID case mortality rate accounting for 11.9% of the variability.  This measure is part of the health behaviors sub measure. 

Access to exercise opportunities is negatively correlated with COVID case mortality with counties having higher mortality rates generally having lower access to exercise opportunities.  This and the other graphs have outliers.  If a correlation were perfect positive or negative, all of the counties would form a perfect straight line sloping upward or downward.  

As always, one should be careful about inferring cause and effect relationships.  These statistics from County Health Rankings were compiled before the coronavirus pandemic began.  Next week I will look at the association of county health ranking measures with Trump's % of the vote.

**Related Posts**

The Seven Counties in PA that are Worse than Cambria in COVID Case Mortality

COVID-19 and County Health Rankings in PA: Which Variables Predict Cases and Deaths

County Health Rankings and Corona Virus Cases: Lower ranked counties have fewer cases in PA (except for Philly)

Pat, Lara, Kevin, Gabby and I: Working for Influence

On Tuesday, I went to a talk by local author Pat Farabaugh on his book Disastrous Floods and the Demise of Steel in Johnstown.  He gave a review of the 3 major floods in Johnstown's history and why the steel mills pulled out of Johnstown a few years after the 1977 flood.  In the interest of full disclosure, my mother's maiden name is also Farabaugh.  We are distant cousins.  We had a nice discussion about our books.  It's always nice to meet other authors.  Here is a link to his book on Amazon.

 

 

Also, the Out D' Coup podcast from Raging Chicken Press (I was interviewed by Kevin Mahoney in 2016) features Lara Putnam, professor of history at the University of Pittsburgh.  Like me, she has written on political shifts in the rust belt.  You can hear her interview with Kevin Mahoney above.  

Finally, I will comment on Gabby Petito.  I confess to being fascinated with this case.  Occasionally, I am taken in by social media feeding frenzies. The news came out on Tuesday about her former fiancé committing suicide by gunshot which was no surprise.  His notebook may hold more interesting revelations about what happened between the two.  I have travelled to the Grand Teton national park as seen in the photo below.

Like Pat, Lara, Kevin, and I, she was an aspiring social media influencer.  She has received much more attention than she would have if she lived.  The case has given me great examples to use in my psychology class on how appearances can be deceiving.  The contrasts between her Instagram posts where her and her fiancé seemed happy and the way she appeared in the Moab Police video where she was eager to excuse his behavior.  He made no effort to excuse her behavior.  Her family appears to be sublimating their grief over her death by creating the Gabby Petito Foundation to assist missing persons and victims of domestic violence.

Me driving through the Tetons in 2016

Other youtubers have put there two cents in on the case.  I have little to add to their commentary.  In addition to making a statement, they are also looking for views and likes of their work.  The competition is omnipresent.  

I admit that the influencing the others and I do is different than what Gabby was planning on doing.  Next week I will be back to posting on COVID in the hopes influencing people to get the vaccine.  Happy Thanksgiving everyone.

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County Health Ranking Factors that Predict COVID Case Mortality in PA

This is the 3rd installment of my posts on case mortality in Pennsylvania.  Before I explained case mortality and looked at counties with the highest rates.  This time I'm looking at which County Health Ranking factors predict COVID Case Mortality at the county level.  This is done to see which health issues occurring in these counties prior to the pandemic predict mortality rates.

County Health Ranking Variable	Correlation with Case mortality (*Significant)
Length of Life	0.30*
Quality of Life	0.17
Health Behaviors	0.29*
Critical Care	0.16
Social and Economic	0.28*
Physical Environment	-0.10
Trump %	0.33*

The above table presents Spearman correlation coefficients for 6 county health ranking sub-measures and Trump % of the vote in 2020 with county case mortality rates.  The length of life, health behaviors, social and economic and Trump% of the vote coefficients were statistically significant and positive.  Scatterplots for these relationships are presented below.

The above plot shows the relationship between the length of life z score (lower is better) for all 67 counties in Pennsylvania and COVID Case mortality.  This relationship accounts for 5.3% of the variability in case mortality.  Sullivan and Juniata counties with high case mortality rates but average length of life scores.

The next graph shows the relationship of health behaviors (lower is better) with COVID case mortality.  This relationship accounts for 6.7% of the variability in case mortality.  As can be seen there is considerable spread in the data.

Social and economic factors (a smaller score is better) was a significant predictor of case mortality but only accounted for 3.1% of the variability in case mortality. Sullivan and Juniata Counties are still outliers for each measure.

Trump's % of the vote is not a factor in County Health Rankings but there is a lot of data showing that counties where Trump is popular having higher COVID rates.  This relationship is stronger than any of the county health ranking factors accounting for 6.9% of the variability in case mortality.  

In a multiple regression model, only the health behaviors measure remains a significant predictor of case mortality.  These county health ranking sub-measures are themselves composites of over 60 individual statistics.  The next step will be to see which of these statistics are significant predictors of case mortality.

**Related Posts**

The Seven Counties in PA that are Worse than Cambria in COVID Case Mortality

A Comparison of State Mortality Rates: Pennsylvania is 6th Highest, Michigan is Highest

The Number of Corona Virus Cases in Cambria County has Grown Exponentially While Health Behaviors Predict Cases in PA

The Seven Counties in PA that are Worse than Cambria in COVID Case Mortality

County	Cases	Deaths	Case Mortality %	Cases per death	Deaths per 100,000	Rank of Deaths per 100.000 in PA	% Fully Vaccinated
JUNIATA	3,009	120	3.99%	25.1	484.6	1	36%
SULLIVAN	607	24	3.95%	25.3	395.7	6	48%
WARREN	4,436	141	3.18%	31.5	359.8	10	41%
NORTHUMBERLAND	13,371	409	3.06%	32.7	450.2	3	51%
TIOGA	4,814	137	2.85%	35.1	337.5	14	39%
MIFFLIN	7,494	212	2.83%	35.3	459.5	2	43%
MONTOUR	2,599	73	2.81%	35.6	400.4	5	68%
CAMBRIA	20,420	535	2.62%	38.2	410.9	4	48%
PENNSYLVANIA	1,608,022	32,188	2.01%	50.0	251.4		51%

Last week I posted on Cambria County's high case mortality rate from COVID.  It has the eighth highest rate in the state.  The case mortality is an estimate of the probability of a person dying when they are diagnosed with the disease.  This week I thought that I would take a look at the seven counties with higher case mortality rates than Cambria.  You can find these states in the map below.

The table above shows the top 8 counties in case mortality from COVID. Juniata County has the worst rate in the state with the probability of dying is one out of 25.1 cases when diagnosed with the disease.  Close behind is Sullivan County with a probability of one in every 25.3 cases.  Cambria's is one in every 38.2 cases.  Pennsylvania's rate is one in every 50 cases.  All of the counties with rates higher than Cambria have populations less than 100,000.

Not surprisingly, the population adjusted mortality rates for each county are higher than the state rate of 251.4 deaths/100,000.  Except for Warren and Tioga, all of them are in the top 8 counties for this metric.  Looking at vaccination rates, 6 of the 8 counties have full vaccination rates lower than the state rate of 51%.  Montour County actually has the highest full vaccination rate in Pennsylvania at 68%.  

 

The rates in the above table are cumulative from the beginning of the pandemic in PA.  Case mortality can vary with time as cases and deaths fluctuate.  The dotted green line shows the 7 day case mortality rate which is the 7 day average for deaths divided by the 7 day average for cases.  A rise in cases precedes a rise in deaths which makes the case mortality decrease.  

Since the vaccine has been rolled out, the cumulative rates decreased from a high of 3.41% on Jan 21 in Cambria to 2.62% today.  Over the same period for Pennsylvania, it decreased from 2.55% to 2.01%.  In the U.S., the rate decreased from 1.67% to 1.62% during this period.  The 7 day case mortality is not a continuous line because there were periods in Cambria where there were no deaths.  

I have written on Montour and Sullivan Counties on this blog before.  In January, Montour had a high rate of vaccinations, hospitalizations and patients on a ventilator.  It still has high rates in these areas.  Sullivan County had one of the highest uninsured rates and the lowest median income in PA before the Affordable Care Act was passed.  

**Related Posts**

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2014 Income and Poverty Update for Pennsylvania and Cambria County

Extreme Outliers in Pennsylvania: Beaver and Montour Counties

Case Mortality in Cambria County Explained

I was thinking about writing about the Gabby Petito case but events here in Cambria County have trumped (no pun intended) that and put it on the back burner.  COVID deaths have been rising again in the county.  On Oct 23 the county reached 500 deaths.  Eleven days later we have reached 521 for an average of 1.91 deaths per day.

The graph above shows the case mortality rates for Cambria County, Pennsylvania, and the U.S.  The case mortality rate is simply the number of deaths divided by the number of cases.  The rates have remained fairly steady for all three entities as the rate of new cases have kept pace with the rate of new deaths.  

The current rate of 2.63% for Cambria may not seem that much larger than the corresponding PA rate of 2.01% and the U.S. rate of 1.62%.  It we take the reciprocal of these rates (cases divided by deaths) we see a different picture.  The reciprocal of Cambria's rate shows that 1 out of every 38 individuals who have COVID has died.  For PA it is 1 out of every 50 cases dying and for the U.S., it is one out of every 62 cases dying.  This means that someone is 31% more likely to die in Cambria than in PA as a whole and 62% nore likely to die than in the U.S. as a whole.

In my last post I talked about how more people are getting the 3rd booster show than are getting the first two.  To date only 48.06% of the county population has received the first two shots.  This number should rise with the approval of the vaccine for children aged 5-11 years old.  Let's hope the rate of vaccinations keeps pace with the rest of the U.S.  The lagging vaccination rate here suggests that most of the recent deaths were preventable.

**Related Posts**

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100 COVID-19 Deaths in Cambria County Since the Candlelight Vigil

More People in Cambria County Getting the Third Booster Shot than Are Getting the First Two Shots

This week, Cambria County reached the grim milestone of 19,000 corona virus cases and 500 deaths since the pandemic began.  Currently, the state has reported that 47.59% of the county's population (children included) has received the first two doses with the current 7 day average for the first two shots at 77.7 per day.  This 7 day average is virtually identical to the 7 day average for new cases which is 72.29 per day as can be seen in the graph above. The above graph is on the logarithmic scale. 

On August 13, the state started to report the number of individuals receiving the third booster shot.  The pink line on the graph above shows that the 7 day average for the 3rd booster has  reached 304.6 per day with a much steeper increase than for those receiving the first to shots.  

It seems likely that those receiving the 3rd shot are many of the same individuals who received the first two in the early days of the vaccine rollout back in January.  Back then there was a similar steep increase in the number of full vaccinations (yellow line) as is seen now with the third booster (pink line).  This is seen in the above graph showing cumulative cases and vaccinations.  There are almost as many 3rd boosters as there are those who received the first shot.  

The nightmare scenario (as I stated before) is that a variant of the virus evolves that is resistant to the vaccine.  In this case we would be back to square one with masks and social distancing.  It took 184 years after Edward Jenner (for whom the town of Jennerstown, PA is named) created the smallpox vaccine for it to eradicate the disease.  How long will it take us?

**Related Posts**

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100 Books Sold and Rosie's Bookapalooza on October 22-24

After a successful book signing at IUP's homecoming two weeks ago, I reached 100 sales of my book Wuthering Depths in Johnstown: By the Numbers.  This weekend coming up I will be selling my book at Rosie's Bookapalooza this weekend at the Community Arts Center of Cambria County.  It will run from Friday Oct. 22 from 10am-5pm to Sat, Oct 23 and Sun, Oct 24 from 10am-3pm.  Five other local authors will be there.

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