Geographic disparities and temporal changes of COVID-19 hospitalization risks in North Dakota

Md Marufuzzaman Khan; Nirmalendu Deb Nath; Matthew Schmidt; Grace Njau; Agricola Odoi

doi:10.3389/fpubh.2023.1062177

Geographic disparities and temporal changes of COVID-19 hospitalization risks in North Dakota

Front Public Health. 2023 Mar 16:11:1062177. doi: 10.3389/fpubh.2023.1062177. eCollection 2023.

Authors

Md Marufuzzaman Khan¹, Nirmalendu Deb Nath², Matthew Schmidt³, Grace Njau³, Agricola Odoi²

Affiliations

¹ Department of Public Health, College of Education, Health, and Human Sciences, University of Tennessee, Knoxville, TN, United States.
² Department of Biomedical and Diagnostic Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN, United States.
³ North Dakota Department of Health and Human Services, Special Projects and Health Analytics, Bismarck, ND, United States.

Abstract

Background: Although the burden of the coronavirus disease 2019 (COVID-19) has been different across communities in the US, little is known about the disparities in COVID-19 burden in North Dakota (ND) and yet this information is important for guiding planning and provision of health services. Therefore, the objective of this study was to identify geographic disparities of COVID-19 hospitalization risks in ND.

Methods: Data on COVID-19 hospitalizations from March 2020 to September 2021 were obtained from the ND Department of Health. Monthly hospitalization risks were computed and temporal changes in hospitalization risks were assessed graphically. County-level age-adjusted and spatial empirical Bayes (SEB) smoothed hospitalization risks were computed. Geographic distributions of both unsmoothed and smoothed hospitalization risks were visualized using choropleth maps. Clusters of counties with high hospitalization risks were identified using Kulldorff's circular and Tango's flexible spatial scan statistics and displayed on maps.

Results: There was a total of 4,938 COVID-19 hospitalizations during the study period. Overall, hospitalization risks were relatively stable from January to July and spiked in the fall. The highest COVID-19 hospitalization risk was observed in November 2020 (153 hospitalizations per 100,000 persons) while the lowest was in March 2020 (4 hospitalizations per 100,000 persons). Counties in the western and central parts of the state tended to have consistently high age-adjusted hospitalization risks, while low age-adjusted hospitalization risks were observed in the east. Significant high hospitalization risk clusters were identified in the north-west and south-central parts of the state.

Conclusions: The findings confirm that geographic disparities in COVID-19 hospitalization risks exist in ND. Specific attention is required to address counties with high hospitalization risks, especially those located in the north-west and south-central parts of ND. Future studies will investigate determinants of the identified disparities in hospitalization risks.

Keywords: COVID-19; FlexScan; Geographic Information Systems; North Dakota; SaTScan; geographic disparities; spatial epidemiology.

Publication types

Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

Bayes Theorem
COVID-19* / epidemiology
Hospitalization
Humans
North Dakota / epidemiology