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J Rural Health ; 37(2): 266-271, 2021 03.
Article in English | MEDLINE | ID: covidwho-1160782


PURPOSE: The COVID-19 pandemic has illuminated various heterogeneities between urban and rural environments in public health. The SARS-CoV-2 virus initially spread into the United States from international ports of entry and into urban population centers, like New York City. Over the course of the pandemic, cases emerged in more rural areas, implicating issues of transportation and mobility. Additionally, many rural areas developed into national hotspots of prevalence and transmission. Our aim was to investigate the preliminary impacts of road travel on the spread of COVID-19. This investigation has implications for future public health mitigation efforts and travel restrictions in the United States. METHODS: County-level COVID-19 data were analyzed for spatiotemporal patterns in time-to-event distributions using animated choropleth maps. Data were obtained from The New York Times and the Bureau of the Census. The arrival event was estimated by examining the number of days between the first reported national case (January 21, 2020) and the date that each county attained a given prevalence rate. Of the 3108 coterminous US counties, 2887 were included in the analyses. Data reflect cases accumulated between January 21, 2020, and May 17, 2020. FINDINGS: Animations revealed that COVID-19 was transmitted along the path of interstates. Quantitative results indicated rural-urban differences in the estimated arrival time of COVID-19. Counties that are intersected by interstates had an earlier arrival than non-intersected counties. The arrival time difference was the greatest in the most rural counties and implicates road travel as a factor of transmission into rural communities. CONCLUSION: Human mobility via road travel introduced COVID-19 into more rural communities. Interstate travel restrictions and road travel restrictions would have supported stronger mitigation efforts during the earlier stages of the COVID-19 pandemic and reduced transmission via network contact.

COVID-19/epidemiology , Rural Population , Travel , Geography, Medical , Humans , Pandemics , United States/epidemiology
EClinicalMedicine ; 32: 100741, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-1071273


BACKGROUND: Suicides by any method, plus 'nonsuicide' fatalities from drug self-intoxication (estimated from selected forensically undetermined and 'accidental' deaths), together represent self-injury mortality (SIM)-fatalities due to mental disorders or distress. SIM is especially important to examine given frequent undercounting of suicides amongst drug overdose deaths. We report suicide and SIM trends in the United States of America (US) during 1999-2018, portray interstate rate trends, and examine spatiotemporal (spacetime) diffusion or spread of the drug self-intoxication component of SIM, with attention to potential for differential suicide misclassification. METHODS: For this state-based, cross-sectional, panel time series, we used de-identified manner and underlying cause-of-death data for the 50 states and District of Columbia (DC) from CDC's Wide-ranging Online Data for Epidemiologic Research. Procedures comprised joinpoint regression to describe national trends; Spearman's rank-order correlation coefficient to assess interstate SIM and suicide rate congruence; and spacetime hierarchical modelling of the 'nonsuicide' SIM component. FINDINGS: The national annual average percentage change over the observation period in the SIM rate was 4.3% (95% CI: 3.3%, 5.4%; p<0.001) versus 1.8% (95% CI: 1.6%, 2.0%; p<0.001) for the suicide rate. By 2017/2018, all states except Nebraska (19.9) posted a SIM rate of at least 21.0 deaths per 100,000 population-the floor of the rate range for the top 5 ranking states in 1999/2000. The rank-order correlation coefficient for SIM and suicide rates was 0.82 (p<0.001) in 1999/2000 versus 0.34 (p = 0.02) by 2017/2018. Seven states in the West posted a ≥ 5.0% reduction in their standardised mortality ratios of 'nonsuicide' drug fatalities, relative to the national ratio, and 6 states from the other 3 major regions a >6.0% increase (p<0.05). INTERPRETATION: Depiction of rising SIM trends across states and major regions unmasks a burgeoning national mental health crisis. Geographic variation is plausibly a partial product of local heterogeneity in toxic drug availability and the quality of medicolegal death investigations. Like COVID-19, the nation will only be able to prevent SIM by responding with collective, comprehensive, systemic approaches. Injury surveillance and prevention, mental health, and societal well-being are poorly served by the continuing segregation of substance use disorders from other mental disorders in clinical medicine and public health practice. FUNDING: This study was partially funded by the National Centre for Injury Prevention and Control, US Centers for Disease Control and Prevention (R49CE002093) and the US National Institute on Drug Abuse (1UM1DA049412-01; 1R21DA046521-01A1).