LAUSR

Background There is a paucity of literature addressing COVID-19 case-fatality ratios (CFR) by zip code (ZC). We aim to analyze trends in COVID-19 CFR, population density, and socioeconomic status (SES) indicators (unemployment, median household income) to identify ZCs heavily burdened by COVID-19. Methods Cross-sectional study to investigate the US prevalence of COVD-19 fatalities by ZC and SES. CFRs were calculated from state/county Departments of Health. Inclusion criteria were counties that reported cases/deaths by ZC and a CFR≥2%. This study was reported in line with the STROCSS criteria. Results 609/1,853 ZCs, spanning 327 counties in 7 states had CFRs ≥2%. A significant positive correlation was found between the CFR and median household income (Pearson correlation:0.107; 95% CI [289.1,1937.9]; p < 0.001). No significant correlations exist between the CFR, and population/mi (Sen-Crowe et al., 2020) [2] or unemployment rate. Significant associations exist between the CFR and young males and elderly females without public insurance. CFR was inversely associated with persons aged <44 and individuals aged ≥65. The percentage of nursing homes (NHs) within cities residing within high CFR ZCs range from 8.7% to 67.6%. Conclusion Significant positive association was found between the CFR and median household income. Population/mi (Sen-Crowe et al., 2020) [2] and unemployment rates, did not correlate to CFR. NHs were heavily distributed in high CFR zip codes. We recommend the targeted vaccination of zip codes with a large proportion of long-term care facilities. Finally, we recommend for improved screening and safety guidelines for vulnerable populations (e.g nursing home residents) and established protocols for when there is evidence of substantial infectious spread.