The Impact of US County-Level Factors on COVID-19 Morbidity and Mortality

Nevo Itzhak, Tomer Shahar, Robert Moskovich, Yuval Shahar

Research output: Contribution to journalArticlepeer-review

9 Scopus citations


The effect of socio-economic factors, ethnicity, and other factors, on the morbidity and mortality of COVID-19 at the sub-population-level, rather than at the individual level, and their temporal dynamics, is only partially understood. Fifty-three county-level features were collected between 4/2020 and 11/2020 from 3,071 US counties from publicly available data of various American government and news websites: ethnicity, socio-economic factors, educational attainment, mask usage, population density, age distribution, COVID-19 morbidity and mortality, presidential election results, and ICU beds. We trained machine learning models that predict COVID-19 mortality and morbidity using county-level features and then performed a SHAP value game theoretic importance analysis of the predictive features for each model. The classifiers produced an AUROC of 0.863 for morbidity prediction and an AUROC of 0.812 for mortality prediction. A SHAP value-based analysis indicated that poverty rate, obesity rate, mean commute time, and mask usage statistics significantly affected morbidity rates, while ethnicity, median income, poverty rate, and education levels heavily influenced mortality rates. Surprisingly, the correlation between several of these factors and COVID-19 morbidity and mortality gradually shifted and even reversed during the study period; our analysis suggests that this phenomenon was probably due to COVID-19 being initially associated with more urbanized areas and, then, from 9/2020, with less urbanized ones. Thus, socio-economic features such as ethnicity, education, and economic disparity are the major factors for predicting county-level COVID-19 mortality rates. Between counties, low variance factors (e.g., age) are not meaningful predictors. The inversion of some correlations over time can be explained by COVID-19 spreading from urban to rural areas.

Original languageEnglish
Pages (from-to)562-570
Number of pages9
JournalJournal of Urban Health
Issue number3
StatePublished - 1 Jun 2022


  • Coronavirus
  • Disparities
  • Ethnicity
  • Socio-economic
  • Temporal distribution
  • Urbanity
  • Vulnerability

ASJC Scopus subject areas

  • Health(social science)
  • Public Health, Environmental and Occupational Health
  • Urban Studies


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