County Health Rankings predict COVID Mortality in the 10 County Area

 

Last year I looked at COVID mortality and County Health Rankings (CHR) numbers for the whole state of PA. This year, the state does not make cumulative mortality numbers readily available. This makes updating the numbers subject to copying error. For this year, I thought I would focus on ten county region surrounding Cambria County.

The 10 county area is listed in the table at the top. The univariate correlation coefficients are presented in the table below for the COVID measures above and the CHR rankings for health outcomes and health factors. Health outcomes is a composite of length of life and quality of life measures. Health factors is a composite of health behaviors, clinical care, social and economic, and physical environment factors. The correlation matrix is presented below. Because of the small sample size, correlation coefficients of 0.632 or higher or -0.632 or lower were flagged as significant and presented in bold below.

	% COVID Fully Vaccinated	Case Mortality %	COVID Case Rate /100,000	COVID Mortality /100,000	Hosp  /100,000	County Health Outcomes Rank	Health Factors Rank
% COVID Fully Vaccinated	1
Case Mortality	-0.738	1.000
COVID Case Rate	0.158	0.311	1.000
COVID Mortality /100,000	-0.579	0.953	0.583	1.000
Hosp /100,000	0.360	-0.440	0.134	-0.339	1.000
County Health Outcomes Rank	-0.289	0.632	0.344	0.642	-0.254	1.000
Health Factors Rank	-0.462	0.730	0.398	0.747	-0.409	0.850	1.000
Length of life rank	-0.297	0.696	0.232	0.659	-0.242	0.896	0.683
Quality of Life Rank	-0.160	0.428	0.368	0.477	-0.254	0.925	0.826
Health Behaviors rank	-0.363	0.678	0.477	0.726	-0.227	0.676	0.913
Clinical Care rank	-0.548	0.803	0.232	0.764	-0.420	0.828	0.785
Soc & Econ Factors rank	-0.357	0.598	0.318	0.608	-0.414	0.843	0.950
Phys env rank	0.031	0.135	-0.381	0.003	-0.242	0.385	0.116

The COVID case and population adjusted mortality rates were most strongly associated with the CHR rankings of length of life, health behaviors, and clinical care. A positive correlation with the rankings suggest that the lower the ranking is, the higher the COVID mortality. Case mortality is simply the number of COVID deaths divided by the number of COVID cases.

The above graph shows the scatter plot for the length of life rank showing a linear association with COVID case mortality. The R squared statistic of 0.485 means that 48.5% of the variability in case mortality is accounted for by the length of life ranking. The regression equation says that for every unit a county is ranked lower, there is a predicted increase of 0.02% in the case mortality. There were no strong outliers in in this plot. 

The strongest correlation for the health factors rankings was clinical care at 0.808. The scatter plot above shows a stronger correlation between that and case mortality accounting for 64.5% of its variability. If it were 100% of the variability, all of the counties would fall on the regression line. Like length of life, the regression equation predicts that for every unit lower that a county is ranked, a 0.02% increase in case mortality should happen.

These sub rankings are themselves composites of dozens of statistics. The individual statistics should shed more light on what variables may be driving COVID vaccination, case, mortality, and hospitalization rates. The devil is always in the details. This will be the next step.

**Related Posts**

County Health Ranking Factors that Predict COVID Case Mortality in PA

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

A look at new Racial Disparity Numbers in Cambria County

2022 PA Primary Post Mortem

The 2022 Pennsylvania primary is almost in the books. State Sen. Doug Mastriano and Lt. Gov. John Fetterman won their respective primaries handily for Governor and U.S. Senator. Attorney General Josh Shapiro was unopposed for the Democratic Nomination for Governor while Dr. Mehmet Oz and and David McCormick are separated by roughly 1,000 votes for the GOP nod for the U.S. Senate.

The graphic above for the Real Clear Politics polling average for the GOP Governors race shows that Mastriano's lead began on April 15 and the gap began to widen on May 4. His actual percentage of the vote was 44% which was 9.7% higher than his final RCP average of 34.5%. The other candidates performed fairly close to their polling averages which suggests that the undecided voters broke for Mastriano in the last days of the campaign. This is partially explained by Trump's last minute endorsement of Mastriano. Jake Corman and Melissa Hart dropping out of the race to endorse Barletta had no effect.

The Senate race in PA has received a lot more scrutiny than the governors race. McCormick received a bigger surge in the last days of the campaign. Oz's percentage of the vote was 4.4% higher than his polling average while McCormick's was 10.5% higher. Kathy Barnette performed almost exactly the same as her polling average. My cousin Casey Contres is biting his nails over this one with the upcoming recounts. Trump's endorsement of Oz did not carry the same weight in this race.

On a local note, State Rep Frank Burns defeated challenger Michael Cashaw 72% to 28%. There were no exit polls in this primary which makes it harder to determine what the voters were thinking. I also have yet to see head to head polling for the Democratic and the GOP candidates for statewide offices for the fall. One bright spot for progressives in PA is that Summer Lee has won her primary for congress in Pittsburgh despite a smear campaign from outside groups. 

**Related Posts**

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A look at new Racial Disparity Numbers in Cambria County

Group	Cambria County	Pennsylvania	U.S.
Overall	75.8	78.1	77.3
White	76.1	78.4	77.6
African American	66.9	73.3	71.8
Hispanic	97.1	82.2	78.8

Two weeks ago I wrote about the new County Health Ranking (CHR) numbers for this year in Cambria County. As before, there was a big discrepancy in life expectancy between African Americans, Whites and Hispanics. The life expectancy estimate for Hispanics may be unreliable as they are a small percentage of the county population. The state life expectancy and racial U.S. life expectancy numbers are are from before the pandemic began.

As before I will go through the other CHR statistics to search for clues for this disparity:

• The percentage of low birthweight babies was 9% for the county and 8% for the state. It was 17% for African Americans, 13% for Hispanics, and 8% for whites.
• The overall child mortality rate was 50/100,000 which was the same as the state rate. It was 160/100,000 for African Americans and 40/100,000 for whites. The African Americans rate was down from 210/100,000 last year and 240/100,000 in 2020.
• The overall infant mortality rate for the county was 7/1,000 live births which was 1% higher than the state rate. For African Americans it was 38/1,000 live births while for whites it was 5/1,000 live births.
• The teen birth rate was 18/1,000 females age 15-19 for the county and 15/1,000 for the state. For African Americans it was 55/1,000, for Hispanics it was 17/1,000 and for whites it was 16/1,000.
• The overall drug overdose mortality rate was 50/100,000 for the county while for the state it was 36/100,000. For African Americans the rate was 117/100,000 while for whites it was 47/100,000. According to overdose free PA, African Americans accounted for 9% of the deaths while they were only 3% of the county population. Whites still accounted for 89% of the overdose deaths.
• The rate of preventable hospital stays was 5,518/100,000 for the county and for the state it was 3,966/100,000. For African Americans it was 7,326/100,000 while for whites it was 5,505/100,000.
• The percentage of female Medicare enrollees receiving a mammogram was 45% for the county and 47% for the state. For Asian Americans it was 23%, it was 38% for African Americans, it was 57% for Hispanics, and it was 45% for whites.
• Forty three percent of the county Medicare enrollees received a flu vaccination while for the state it was 54%. For Asian Americans it was 20%. For African Americans it was 36%. For Hispanics it was 46% and for whites it was 43%.
• The overall child poverty rate for the county was 16% while for the state it was 14%. For Asians it was 15%, for African Americans it was 57%, for Hispanics it was 35% and for whites it was 19%.
• The injury death rate was 133/100,000 for the county while it was 93/100,000 for the state. For African Americans it was 220/100,000 and for whites it was 131/100,000.
• The average 3rd grade reading test level was 3.1 grade for the county which was the same as the state rate. For African Americans it was at the 2.2 grade level and at the 3.2 grade level.
• The average math test level for 3rd graders was also at the 3.1 grade level which was also the same as the state rate. For African Americans it was at the 2.0 grade level while for whites it was at the 3.2 grade level.
• Median household income for the county was $48,700 while for the state it was $64,900. For Asian Americans it was $100,100, for African Americans it was $28,500, for Hispanics it was $40,200, and for whites it was $48,900.
• The homicide rate for the county was 5/100,000 while for the state it was 6/100,000. For African Americans it was 48/100,000 and for whites it was 3/100,000.
• Eighty one percent of the county drives alone to work while for the state it was 74%. For African Americans it was 59%, for Hispanics it was 62% and for whites it was 83%.

Each year CHR provides more detailed information to explain the racial disparities in the health of the area. The next step is to take action to remedy these disparities. 

Coronavirus numbers for the cases and deaths county were not broken down by race at the county level. However, case rates are provided at the zip code level. The vast majority of African Americans in the county live in and around the city of Johnstown. Case rates are higher outside of Johnstown than in the city and its suburbs (zip codes 15901 to 15909) as can be seen in the graph below.

 

**Related Posts**

Why do African Americans live to be 64.8 years in Cambria County?

Some Clues for Racial Disparities for Cambria County

African Americans Still Lag Behind in Life Expectancy in Cambria County