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**

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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.  

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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.

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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?

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Columbus (or Indigenous People's) Day Reflections on COVID in PA

This weekend, the State of Pennsylvania only released case and hospitalization numbers, not death and vaccination numbers.  I assume that this is because of the Columbus (or Indigenous People's) Day is a state holiday.  This provides an opportunity to reflect on the state of the corona virus pandemic.  

The state has started to provide numbers of child cases each week.  This is in response to all of the controversy over mask mandates in schools.  Above are the numbers for Cambria County for the school year for the 0-4 age group (blue line) and the 5-18 age group (red line).  The graph is on the logarithmic scale to make it easier to see changes in both groups.  The trendlines are linear but are not straight because of the logarithmic scale and account for more than 95% of the variability for both age groups.

The elderly are still the most vulnerable to the virus as there are a total of 8 deaths in PA for ages 0-18 out of 29,907 total so far while 85.2% of total deaths are age 65 and older in PA.  Cases are more prevalent in age groups from 20-59 years old as seen in the graphs above.  

For gender, there are more cases among women but men are 17% more likely to die from the disease.  Race is not reported for 28% of cases but it is for all deaths.  The population adjusted mortality rate is lowest for Asian Americans in PA at 88.16 deaths/100,000 followed by Hispanics at 123.58/100,000.  African American and Caucasian rates are virtually equal at 228.13/100,000 and 234.44.100,000 respectively.  Individuals in multiple or other racial/ethnic groups have the highest mortality rate at 998.87/100,000.  

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Jay Wiedwald's Graphs on "Johnstown" and "Halo" Counties and Coronavirus

 

A follower of my blog named Jay Wiedwald shared some graphs showing how the counties immediately surrounding Cambria have been adversely affected by corona virus.  Jay is a former resident of Johnstown who lived in Moxham.  He includes Bedford, Blair, Cambria, Indiana, and Somerset counties as Johnstown and the surrounding counties ad "Halo" counties.  

In the graph that he created above, he computed the excess death rates from coronavirus for the "Johnstown" Counties, the "Halo" Counties, and Pennsylvania overall.  Excess death rates compared death rates for last fall and winter to death rates from previous years on the same day.  It shows that the Johnstown Counties had higher death rates after the Trump rally on October 13 compared to PA and the "halo" counties.

The graph above also shows a steady increase in case mortality rates for Cambria County after the Trump rally indicated by the yellow dot.  These are changes in the cumulative rates since the beginning of the pandemic.  Currently Cambria's rate (2.89%) is 33% higher that Pennsylvania's and 77% higher than the U.S. case mortality rate.  Recently the rates for Cambria, PA and the U.S. have declined due to the number of cases rising faster than the number of deaths.  The decline for PA and the U.S. has been steeper than Cambria's.

The table below summarizes the "Johnstown" and "Halo" counties for COVID mortality as of this writing.  I only have date for the PA 'Halo' counties. The 'Johnstown' counties indeed do have higher case and population adjusted mortality than PA or the "Halo" counties.  The "Halo" counties have a slightly lower case mortality rate than PA (2.07% for halo vs. 2.17% for PA) but the population adjusted rate is slightly higher for PA (222.60 for halo vs. 221.15 for PA).  The "Johnstown" counties have a 28% higher case mortality rate (2.78% for 'Johnstown' vs. 2.17% for PA) a 33% higher population adjusted mortality rate 293.6 for 'Johnstown' vs. 221.25 for PA.

Thank you Jay for Bringing this to my attention.  

Johnstown Counties	Cases	Deaths	Case mortality	Population	Deaths/100000
Bedford	5,045	144	2.85%	47,888	300.70
Blair	14,126	346	2.45%	121,829	284.00
Cambria	15,570	449	2.88%	130,192	344.88
Indiana	6,928	184	2.66%	84,073	218.86
Somerset	6,561	220	3.35%	73,447	299.54
Total 'Johnstown' Counties	48,230	1,343	2.78%	457,429	293.60
PA	1,308,284	28,325	2.17%	12,801,989	221.25
Halo Counties	Cases	Deaths	Case mortality	Population	Deaths/100000
Armstrong	6,434	151	2.35%	64,735	233.26
Centre	17,766	231	1.30%	162,385	142.25
Clearfield	9,264	166	1.79%	79,255	209.45
Fayette	14,231	335	2.35%	129,274	259.14
Franklin	16,925	381	2.25%	155,027	245.76
Fulton	1,513	18	1.19%	14,530	123.88
Huntingdon	5,502	137	2.49%	45,144	303.47
Jefferson	3,568	100	2.80%	43,425	230.28
Westmoreland	36,940	802	2.17%	348,899	229.87
Total ‘Halo’ Counties	112,143	2,321	2.07%	1,042,674	222.60
PA	1,308,284	28,325	2.17%	12,801,989	221.25

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