County COVID-19 death rates in the United States were associated with higher perceptions of risk and subsequently greater time spent at home, according to a study published in The Journal of Infectious Diseases. This finding can help inform voluntary nonpharmaceutical measures that would help curb the spread of COVID-19.
Investigators collected survey data on demographics, risk perception, time spent at home, and death rate via CloudResearch/Qualtrics, Johns Hopkins University, the American Community Survey, and SafeGraph. A total of 672 participants (72%) completed the survey; 57% were women, 38% were aged 55 years or older, 65% identified as non-Hispanic White, 52% had college or graduate degrees, and 76% did not have a chronic illness. The sample represented 347 counties and 46 states.
County death rates per 100,000 were divided into 3 categories: low (≤5 deaths, n = 220), moderate (6-17 deaths, n = 218), and high (>17 deaths, n=214). The median was 8.4 deaths (range, 0-1250). Based on a 10-point scale and after adjusting for gender, age, education, race/ethnicity, and chronic illness, individuals in counties with high death rates had a 4.5% increase in risk perception, compared with those in counties with low death rates. There was no difference in overall risk perception between counties with moderate and low death rates.
County data on time spent at home ranged from 413 to 1071 minutes (median, 793) and was categorized as low (351-709 minutes, n=223), moderate (710-815 minutes, n=224), or high (816-1043 minutes, n=222). After adjusting for gender, age, employment status, stay-at-home order status, work in healthcare, and chronic illness, increased odds of spending more time at home was associated with an increase in risk perception (OR, 1.12; 95% CI, 1.04%-1.20%; P ≤.01). A sensitivity analysis revealed that after controlling for gender, age, employment status, stay-at-home order status, work in healthcare, and chronic illness, a unit increase in risk perception led to an additional 7.6 minutes at home.
Investigators note that while the study is geographically represented, 68% of the sample came from high-risk counties, which might have biased the results. The survey was also conducted online and exclusively in English and results may not be generalizable to those without access to technology and non-English speakers.
According to the investigators, American adults voluntarily spent more time at home in response to higher perceptions of risk. This data may help improve future communication campaigns aimed at voluntary uptake of preventative public health measures.
Elharake JA, Shafiq M, McFadden SM, Malik AA, Omer SB. The Association of COVID-19 risk perception, county death rates, and voluntary health behaviors among U.S. adult population. J Infect Dis. Published online March 10, 2021. doi:10.1093/infdis/jiab131