Associations between county-level public health expenditures and community health planning activities with COVID-19 incidence and mortality
The COVID-19 pandemic has revealed consequences of past defunding of the U.S. public health system, but the extent to which public health infrastructure is associated with COVID-19 burden is unknown. We aimed to determine whether previous county-level public health expenditures and community health...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2023-12-01
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| Series: | Preventive Medicine Reports |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2211335523003017 |
| _version_ | 1797686892032950272 |
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| author | Richard Liang Mathew V. Kiang Philip Grant Christian Jackson David H. Rehkopf |
| author_facet | Richard Liang Mathew V. Kiang Philip Grant Christian Jackson David H. Rehkopf |
| author_sort | Richard Liang |
| collection | DOAJ |
| description | The COVID-19 pandemic has revealed consequences of past defunding of the U.S. public health system, but the extent to which public health infrastructure is associated with COVID-19 burden is unknown. We aimed to determine whether previous county-level public health expenditures and community health planning activities are associated with COVID-19 cases and deaths. We examined 3050 of 3143 U.S. counties and county equivalents from March 1, 2020 to February 28, 2022. Multivariable-adjusted linear regression and generalized additive models were used to estimate associations between county-level public health expenditures and completion of community health planning activities by a county health department with outcomes of county-level COVID-19 cases and deaths per 100,000 population. After adjusting for county-level covariates, counties in the highest tertile of public health expenditures per capita had on average 542 fewer COVID-19 cases per 100,000 population (95% CI, −1004 to −81) and 21 fewer deaths per 100,000 population (95% CI, –32 to −10) than counties in the lowest tertile. For analyses of community health planning activities, adjusted estimates of association remained negative for COVID-19 deaths, but confidence intervals included negative and positive values. In conclusion, higher levels of local public health expenditures and community health planning activities were associated with fewer county-level COVID-19 deaths, and to a lesser extent, cases. Future public health funding should be aligned with evidence for the value of county health departments programs and explore further which types of spending are most cost effective. |
| first_indexed | 2024-03-12T01:11:09Z |
| format | Article |
| id | doaj.art-d06eb2d2503e4029b8d36b2880b59bd8 |
| institution | Directory Open Access Journal |
| issn | 2211-3355 |
| language | English |
| last_indexed | 2024-03-12T01:11:09Z |
| publishDate | 2023-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Preventive Medicine Reports |
| spelling | doaj.art-d06eb2d2503e4029b8d36b2880b59bd82023-09-14T04:53:27ZengElsevierPreventive Medicine Reports2211-33552023-12-0136102410Associations between county-level public health expenditures and community health planning activities with COVID-19 incidence and mortalityRichard Liang0Mathew V. Kiang1Philip Grant2Christian Jackson3David H. Rehkopf4Stanford University School of Medicine, Department of Epidemiology and Population Health, Alway Building, 300 Pasteur Drive, Stanford, CA 94305, United States; Corresponding author.Stanford University School of Medicine, Department of Epidemiology and Population Health, Alway Building, 300 Pasteur Drive, Stanford, CA 94305, United StatesStanford University School of Medicine, Department of Medicine – Infectious Diseases, 300 Pasteur Drive, Lane Building 134, Stanford, CA 94305, United StatesStanford University School of Medicine, Department of Epidemiology and Population Health, Alway Building, 300 Pasteur Drive, Stanford, CA 94305, United StatesStanford University School of Medicine, Department of Epidemiology and Population Health, Alway Building, 300 Pasteur Drive, Stanford, CA 94305, United States; Stanford University School of Medicine, Division of Primary Care and Population Health, 1265 Welch Road, Stanford, CA 94305, United States; Stanford University, Department of Sociology, 450 Jane Stanford Way, Building 120, Room 160, Stanford, CA 94305, United States; Stanford University, Center for Population Health Sciences, 1701 Page Mill Road, Palo Alto, CA 94304, United StatesThe COVID-19 pandemic has revealed consequences of past defunding of the U.S. public health system, but the extent to which public health infrastructure is associated with COVID-19 burden is unknown. We aimed to determine whether previous county-level public health expenditures and community health planning activities are associated with COVID-19 cases and deaths. We examined 3050 of 3143 U.S. counties and county equivalents from March 1, 2020 to February 28, 2022. Multivariable-adjusted linear regression and generalized additive models were used to estimate associations between county-level public health expenditures and completion of community health planning activities by a county health department with outcomes of county-level COVID-19 cases and deaths per 100,000 population. After adjusting for county-level covariates, counties in the highest tertile of public health expenditures per capita had on average 542 fewer COVID-19 cases per 100,000 population (95% CI, −1004 to −81) and 21 fewer deaths per 100,000 population (95% CI, –32 to −10) than counties in the lowest tertile. For analyses of community health planning activities, adjusted estimates of association remained negative for COVID-19 deaths, but confidence intervals included negative and positive values. In conclusion, higher levels of local public health expenditures and community health planning activities were associated with fewer county-level COVID-19 deaths, and to a lesser extent, cases. Future public health funding should be aligned with evidence for the value of county health departments programs and explore further which types of spending are most cost effective.http://www.sciencedirect.com/science/article/pii/S2211335523003017Public Health FinanceSocial Determinants of HealthData LinkagePublic Health InfrastructureLocal Health DepartmentsCOVID-19 |
| spellingShingle | Richard Liang Mathew V. Kiang Philip Grant Christian Jackson David H. Rehkopf Associations between county-level public health expenditures and community health planning activities with COVID-19 incidence and mortality Preventive Medicine Reports Public Health Finance Social Determinants of Health Data Linkage Public Health Infrastructure Local Health Departments COVID-19 |
| title | Associations between county-level public health expenditures and community health planning activities with COVID-19 incidence and mortality |
| title_full | Associations between county-level public health expenditures and community health planning activities with COVID-19 incidence and mortality |
| title_fullStr | Associations between county-level public health expenditures and community health planning activities with COVID-19 incidence and mortality |
| title_full_unstemmed | Associations between county-level public health expenditures and community health planning activities with COVID-19 incidence and mortality |
| title_short | Associations between county-level public health expenditures and community health planning activities with COVID-19 incidence and mortality |
| title_sort | associations between county level public health expenditures and community health planning activities with covid 19 incidence and mortality |
| topic | Public Health Finance Social Determinants of Health Data Linkage Public Health Infrastructure Local Health Departments COVID-19 |
| url | http://www.sciencedirect.com/science/article/pii/S2211335523003017 |
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