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1. Associations between rurality and regional differences in sociodemographic factors and the 1918–20 influenza and 2020–21 COVID-19 pandemics in Missouri counties: An ecological study

   https://doi.org/10.1371/journal.pone.0290294  

   Sattenspiel, Lisa; Orbann, Carolyn; Bogan, Aaron; Ramirez, Hailey; Pirrone, Sean; Dahal, Sushma; McElroy, Jane A.; Wikle, Christopher K. (August 2023, PLOS ONE)

   Acharya, Binod (Ed.)

   This study compares pandemic experiences of Missouri’s 115 counties based on rurality and sociodemographic characteristics during the 1918–20 influenza and 2020–21 COVID-19 pandemics. The state’s counties and overall population distribution have remained relatively stable over the last century, which enables identification of long-lasting pandemic attributes. Sociodemographic data available at the county level for both time periods were taken from U.S. census data and used to create clusters of similar counties. Counties were also grouped by rural status (RSU), including fully (100%) rural, semirural (1–49% living in urban areas), and urban (>50% of the population living in urban areas). Deaths from 1918 through 1920 were collated from the Missouri Digital Heritage database and COVID-19 cases and deaths were downloaded from the Missouri COVID-19 dashboard. Results from sociodemographic analyses indicate that, during both time periods, average farm value, proportion White, and literacy were the most important determinants of sociodemographic clusters. Furthermore, the Urban/Central and Southeastern regions experienced higher mortality during both pandemics than did the North and South. Analyses comparing county groups by rurality indicated that throughout the 1918–20 influenza pandemic, urban counties had the highest and rural had the lowest mortality rates. Early in the 2020–21 COVID-19 pandemic, urban counties saw the most extensive epidemic spread and highest mortality, but as the epidemic progressed, cumulative mortality became highest in semirural counties. Additional results highlight the greater effects both pandemics had on county groups with lower rates of education and a lower proportion of Whites in the population. This was especially true for the far southeastern counties of Missouri (“the Bootheel”) during the COVID-19 pandemic. These results indicate that rural-urban and socioeconomic differences in health outcomes are long-standing problems that continue to be of significant importance, even though the overall quality of health care is substantially better in the 21 st century. 

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2. Commuting Network Spillovers and COVID-19 Deaths Across US Counties

   Seto, Christopher; Khademi, Aria; Graif, Corina; Honavar, Vasant (January 2021, ArXivorg)

   This study explored how population mobility flows form commuting networks across US counties and influence the spread of COVID-19. We utilized 3-level mixed effects negative binomial regression models to estimate the impact of network COVID-19 exposure on county confirmed cases and deaths over time. We also conducted weighting-based analyses to estimate the causal effect of network exposure. Results showed that commuting networks matter for COVID-19 deaths and cases, net of spatial proximity, socioeconomic, and demographic factors. Different local racial and ethnic concentrations are also associated with unequal outcomes. These findings suggest that commuting is an important causal mechanism in the spread of COVID-19 and highlight the significance of interconnected of communities. The results suggest that local level mitigation and prevention efforts are more effective when complemented by similar efforts in the network of connected places. Implications for research on inequality in health and flexible work arrangements are discussed. 

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3. Ensemble machine learning of factors influencing COVID-19 across US counties

   https://doi.org/10.1038/s41598-021-90827-x  

   McCoy, David; Mgbara, Whitney; Horvitz, Nir; Getz, Wayne M.; Hubbard, Alan (December 2021, Scientific Reports)

   Abstract Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) the causal agent for COVID-19, is a communicable disease spread through close contact. It is known to disproportionately impact certain communities due to both biological susceptibility and inequitable exposure. In this study, we investigate the most important health, social, and environmental factors impacting the early phases (before July, 2020) of per capita COVID-19 transmission and per capita all-cause mortality in US counties. We aggregate county-level physical and mental health, environmental pollution, access to health care, demographic characteristics, vulnerable population scores, and other epidemiological data to create a large feature set to analyze per capita COVID-19 outcomes. Because of the high-dimensionality, multicollinearity, and unknown interactions of the data, we use ensemble machine learning and marginal prediction methods to identify the most salient factors associated with several COVID-19 outbreak measure. Our variable importance results show that measures of ethnicity, public transportation and preventable diseases are the strongest predictors for both per capita COVID-19 incidence and mortality. Specifically, the CDC measures for minority populations, CDC measures for limited English, and proportion of Black- and/or African-American individuals in a county were the most important features for per capita COVID-19 cases within a month after the pandemic started in a county and also at the latest date examined. For per capita all-cause mortality at day 100 and total to date, we find that public transportation use and proportion of Black- and/or African-American individuals in a county are the strongest predictors. The methods predict that, keeping all other factors fixed, a 10% increase in public transportation use, all other factors remaining fixed at the observed values, is associated with increases mortality at day 100 of 2012 individuals (95% CI [1972, 2356]) and likewise a 10% increase in the proportion of Black- and/or African-American individuals in a county is associated with increases total deaths at end of study of 2067 (95% CI [1189, 2654]). Using data until the end of study, the same metric suggests ethnicity has double the association as the next most important factors, which are location, disease prevalence, and transit factors. Our findings shed light on societal patterns that have been reported and experienced in the U.S. by using robust methods to understand the features most responsible for transmission and sectors of society most vulnerable to infection and mortality. In particular, our results provide evidence of the disproportionate impact of the COVID-19 pandemic on minority populations. Our results suggest that mitigation measures, including how vaccines are distributed, could have the greatest impact if they are given with priority to the highest risk communities. 

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4. Interpreting County-Level COVID-19 Infections using Transformer and Deep Learning Time Series Models

   https://doi.org/10.1109/ICDH60066.2023.00046  

   Islam, Md Khairul; Liu, Yingzheng; Erkelens, Andrej; Daniello, Nick; Marathe, Aparna; Fox, Judy (July 2023, IEEE)

   Deep Learning for Time-series plays a key role in AI for healthcare. To predict the progress of infectious disease outbreaks and demonstrate clear population-level impact, more granular analyses are urgently needed that control for important and potentially confounding county-level socioeconomic and health factors. We forecast US county-level COVID-19 infections using the Temporal Fusion Transformer (TFT). We focus on heterogeneous time-series deep learning model prediction while interpreting the complex spatiotemporal features learned from the data. The significance of the work is grounded in a real-world COVID-19 infection prediction with highly non-stationary, finely granular, and heterogeneous data. 1) Our model can capture the detailed daily changes of temporal and spatial model behaviors and achieves better prediction performance compared to other time-series models. 2) We analyzed the attention patterns from TFT to interpret the temporal and spatial patterns learned by the model. 3) We collected around 2.5 years of socioeconomic and health features for 3142 US counties, such as observed cases, and a number of static (age distribution and health disparity) and dynamic features (vaccination, disease spread, transmissible cases, and social distancing). Using the proposed framework, we have shown that our model can learn complex interactions. Interpreting different impacts at the county level would be crucial for understanding the infection process that can help effective public health decision-making. 

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5. Interpreting County-Level COVID-19 Infections using Transformer and Deep Learning Time Series Models

   https://doi.org/10.1109/ICDH60066.2023.00046  

   Islam, K; Liu, Y.; Erkelens, A.; Daniello, N.; Marathe, A.; Fox, J. (February 2023, IEEE International Conference on Digital Health (ICDH))

   Deep Learning for Time-series plays a key role in AI for healthcare. To predict the progress of infectious disease outbreaks and demonstrate clear population-level impact, more granular analyses are urgently needed that control for important and potentially confounding county-level socioeconomic and health factors. We forecast US county-level COVID-19 infections using the Temporal Fusion Transformer (TFT). We focus on heterogeneous time-series deep learning model prediction while interpreting the complex spatiotemporal features learned from the data. The significance of the work is grounded in a real-world COVID-19 infection prediction with highly non-stationary, finely granular, and heterogeneous data. 1) Our model can capture the detailed daily changes of temporal and spatial model behaviors and achieves better prediction performance compared to other time-series models. 2) We analyzed the attention patterns from TFT to interpret the temporal and spatial patterns learned by the model. 3) We collected around 2.5 years of socioeconomic and health features for 3142 US counties, such as observed cases, and a number of static (age distribution and health disparity) and dynamic features (vaccination, disease spread, transmissible cases, and social distancing). Using the proposed framework, we have shown that our model can learn complex interactions. Interpreting different impacts at the county level would be crucial for understanding the infection process that can help effective public health decision-making. 

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