Healthcare Access and County-Level COVID-19 Mortality: Exploring the Impact of Hospital Proximity and Uninsurance Rates

Background/Objectives: Many social and environmental factors contribute to the disproportionate burden of COVID-19 mortality. Access to healthcare services has not been thoroughly examined as a factor contributing to COVID-19 mortality. This study examines distance to ERs and ICUs, uninsurance rates, and county-level COVID-19 mortality rates. Methods: Using data from the American Hospital Association survey, we identified hospitals providing emergency and intensive care services. Hospital locations were geocoded, and straight-line distance was calculated from the population-weighted county centroid. The county proportion of uninsured residents came from the American Community Survey. Generalized linear regression models with a log-link were used to examine study factors and county COVID-19 mortality rates. Results: A total of 2640 (84.0%) U.S. counties or county-equivalents were included in this analysis. The median COVID-19 mortality rate was 240 deaths per 100,000. In adjusted models, increasing distance to ERs (IRR: 0.95; 95% CI: 0.92, 0.98) or ICUs (IRR: 0.61; 95% CI: 0.57, 0.65) was not significantly associated with increased COVID-19 mortality. The proportion of residents (IRR: 3.81; CI: 2.58, 5.62) uninsured was significantly associated with increased COVID-19 mortality rates. Conclusions: Being in close proximity to hospital-based healthcare services may not provide any significant benefit for COVID-19 mortality outcomes, considering that hospitals are largely located in more densely populated areas conducive to COVID-19 spread. Financial barriers may largely contribute to persons avoiding necessary COVID-19 care. To continue to combat COVID-19 and future pandemics, greater attention should be focused on eliminating financial barriers to receiving medically necessary care.