Explaining the Varying Patterns of COVID-19 Deaths Across the United States: 2-Stage Time Series Clustering Framework

Background: Socially vulnerable communities are at increased risk for adverse health outcomes during a pandemic. Although this association has been established for H1N1, Middle East respiratory syndrome (MERS), and COVID-19 outbreaks, understanding the factors influencing the outbreak pattern for different communities remains limited.Objective: Our 3 objectives are to determine how many distinct clusters of time series there are for COVID-19 deaths in 3108 contiguous counties in the United States, how the clusters are geographically distributed, and what factors influence the probability of cluster membership.Methods: We proposed a 2-stage data analytic framework that can account for different levels of temporal aggregation for the pandemic outcomes and community-level predictors. Specifically, we used time-series clustering to identify clusters with similar outcome patterns for the 3108 contiguous US counties. Multinomial logistic regression was used to explain the relationship between community-level predictors and cluster assignment. We analyzed county-level confirmed COVID-19 deaths from Sunday,Results: Four distinct patterns of deaths were observed across the contiguous US counties. The multinomial regression model correctly classified 1904 (61.25%) of the counties' outbreak patterns/clusters. Conclusions: Our results provide evidence that county-level patterns of COVID-19 deaths are different and can be explained in part by social and political predictors.