Xanna Burg, Jessica Jarick Metcalfe, Brenna Ellison, Melissa Pflugh Prescott
Effects of Longer Seated Lunch Time on Food Consumption and Waste in Elementary and Middle School-age Children: A Randomized Clinical Trial
JAMA network open
usa struggled responding covid19 pandemic states struggled equally identifying factors associated crossstate variation infection mortality rates could help improve responses future pandemics sought answer five key policyrelevant questions regarding following 1 roles social economic racial inequities interstate variation covid19 outcomes 2 whether states greater healthcare public health capacity better outcomes 3 politics influenced results 4 whether states imposed policy mandates sustained longer better outcomes 5 whether tradeoffs state fewer cumulative sarscov2 infections total covid19 deaths economic educational outcomes data disaggregated us state extracted public databases including covid19 infection mortality estimates institute health metrics evaluations ihme covid19 database bureau economic analysis data state gross domestic product gdp federal reserve economic data employment rates national center education statistics data student standardised test scores us census bureau data race ethnicity state standardised infection rates population density death rates age prevalence major comorbidities facilitate comparison states successes mitigating effects covid19 regressed health outcomes prepandemic state characteristics educational attainment health spending per capita policies adopted states pandemic mask mandates business closures populationlevel behavioural responses vaccine coverage mobility explored potential mechanisms connecting statelevel factors individuallevel behaviours using linear regression quantified reductions state gdp employment student test scores pandemic identify policy behavioural responses associated outcomes assess tradeoffs outcomes covid19 outcomes significance defined p005 standardised cumulative covid19 death rates period jan 1 2020 july 31 2022 varied across usa national rate 372 deaths per 100 000 population 95 uncertainty interval ui 364379 lowest standardised rates hawaii 147 deaths per 100 000 127196 new hampshire 215 per 100 000 183271 highest arizona 581 per 100 000 509672 washington dc 526 per 100 000 425631 lower poverty rate higher mean number years education greater proportion people expressing interpersonal trust statistically associated lower infection death rates states larger percentages population identify black nonhispanic hispanic associated higher cumulative death rates access quality health care measured ihmes healthcare access quality index associated fewer total covid19 deaths sarscov2 infections higher public health spending public health personnel per capita state level political affiliation state governor associated lower sarscov2 infection covid19 death rates worse covid19 outcomes associated proportion states voters voted 2020 republican presidential candidate state governments uses protective mandates associated lower infection rates mask use lower mobility higher vaccination rate vaccination rates associated lower death rates state gdp student reading test scores associated state covd19 policy responses infection rates death rates employment however statistically significant relationship restaurant closures greater infections deaths average 1574 95 ui 8847107 additional infections per 10 000 population associated states one percentage point increase employment rate several policy mandates protective behaviours associated lower fourthgrade mathematics test scores study results find link statelevel estimates school closures covid19 magnified polarisation persistent social economic racial inequities already existed across us society next pandemic threat need us states mitigated structural inequalities deployed sciencebased interventions vaccination targeted vaccine mandates promoted adoption across society able match bestperforming nations minimising covid19 death rates findings could contribute design targeting clinical policy interventions facilitate better health outcomes future crises bill melinda gates foundation j stanton gillespie j e nordstrom bloomberg philanthropies