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Comparison of Estimated Rates of Coronavirus Disease 2019 (COVID-19) in Border Counties in Iowa Without a Stay-at-Home Order and Border Counties in Illinois With a Stay-at-Home Order.
JAMA Netw Open. 2020 05 01; 3(5):e2011102.JN

Abstract

Importance

Iowa is 1 of 5 states in the US that have not issued a stay-at-home order during the coronavirus disease 2019 (COVID-19) pandemic. There is no empirical evidence on whether issuing a stay-at-home order in Iowa could have been associated with a reduced rate of COVID-19 infections in the state.

Objective

To compare COVID-19 cases in border counties in Iowa, which did not issue a stay-at-home order, with cases in border counties in Illinois, which did issue a stay-at-home order.

Design, Setting, and Participants

This cross-sectional study with a difference-in-differences design compared daily changes in COVID-19 cases per 10 000 residents in 8 Iowa counties bordering Illinois with those in the 7 Illinois counties bordering Iowa before and after Illinois issued a stay-at-home order on March 21, 2020. Additional sensitivity analyses were conducted to account for differences in timing of closing schools and nonessential businesses between the 2 states and differential trends in COVID-19 cases by county population density and poverty rates.

Exposures

Issuing a stay-at-home order.

Main Outcomes and Measures

Comparison of cumulative cases of COVID-19 per 10 000 residents in border counties in Iowa and Illinois.

Results

The total populations were 462 445 in the Iowa border counties and 272 385 in the Illinois border counties. Population density was higher in the Iowa counties (114.2 people per square mile) than in the Illinois counties (78.2 people per square mile). Trends of cumulative COVID-19 cases per 10 000 residents for the Iowa and Illinois border counties were comparable before the Illinois stay-at-home order, which went into effect at 5:00 pm on March 21 (March 15 to March 21: 0.024 per 10 000 residents vs 0.026 per 10 000 residents). After that, cases increased more quickly in Iowa and more slowly in Illinois. Within 10, 20, and 30 days after the enactment of the stay-at-home order in Illinois, the difference in cases was -0.51 per 10 000 residents (SE, 0.09; 95% CI, -0.69 to -0.32; P < .001), -1.15 per 10 000 residents (SE, 0.49; 95% CI, -2.12 to -0.18; P = .02), and -4.71 per 10 000 residents (SE, 1.99; 95% CI, -8.64 to -0.78; P = .02), respectively. The estimates indicate excess cases in the border Iowa counties by as many as 217 cases after 1 month without a stay-at-home order. This estimate of excess cases represents 30.4% of the 716 total cases in those Iowa counties by that date. Sensitivity analyses addressing differences in timing of closing schools and nonessential businesses and differences in county population density and poverty rates between the 2 states supported these findings.

Conclusions and Relevance

This cross-sectional study with a difference-in-differences design found an increase in estimated rates of COVID-19 cases per 10 000 residents in the border counties in Iowa compared with the border counties in Illinois following a stay-at-home order that was implemented in Illinois but not in Iowa.

Authors+Show Affiliations

Department of Health Management and Policy, The University of Iowa, Iowa City.Department of Health Management and Policy, The University of Iowa, Iowa City. Department of Economics, The University of Iowa, Iowa City. Department of Preventive and Community Dentistry, The University of Iowa, Iowa City. Public Policy Center, The University of Iowa, Iowa City. National Bureau of Economic Research, Cambridge, Massachusetts.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

32413112

Citation

Lyu, Wei, and George L. Wehby. "Comparison of Estimated Rates of Coronavirus Disease 2019 (COVID-19) in Border Counties in Iowa Without a Stay-at-Home Order and Border Counties in Illinois With a Stay-at-Home Order." JAMA Network Open, vol. 3, no. 5, 2020, pp. e2011102.
Lyu W, Wehby GL. Comparison of Estimated Rates of Coronavirus Disease 2019 (COVID-19) in Border Counties in Iowa Without a Stay-at-Home Order and Border Counties in Illinois With a Stay-at-Home Order. JAMA Netw Open. 2020;3(5):e2011102.
Lyu, W., & Wehby, G. L. (2020). Comparison of Estimated Rates of Coronavirus Disease 2019 (COVID-19) in Border Counties in Iowa Without a Stay-at-Home Order and Border Counties in Illinois With a Stay-at-Home Order. JAMA Network Open, 3(5), e2011102. https://doi.org/10.1001/jamanetworkopen.2020.11102
Lyu W, Wehby GL. Comparison of Estimated Rates of Coronavirus Disease 2019 (COVID-19) in Border Counties in Iowa Without a Stay-at-Home Order and Border Counties in Illinois With a Stay-at-Home Order. JAMA Netw Open. 2020 05 1;3(5):e2011102. PubMed PMID: 32413112.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparison of Estimated Rates of Coronavirus Disease 2019 (COVID-19) in Border Counties in Iowa Without a Stay-at-Home Order and Border Counties in Illinois With a Stay-at-Home Order. AU - Lyu,Wei, AU - Wehby,George L, Y1 - 2020/05/01/ PY - 2020/5/16/entrez PY - 2020/5/16/pubmed PY - 2020/5/27/medline SP - e2011102 EP - e2011102 JF - JAMA network open JO - JAMA Netw Open VL - 3 IS - 5 N2 - Importance: Iowa is 1 of 5 states in the US that have not issued a stay-at-home order during the coronavirus disease 2019 (COVID-19) pandemic. There is no empirical evidence on whether issuing a stay-at-home order in Iowa could have been associated with a reduced rate of COVID-19 infections in the state. Objective: To compare COVID-19 cases in border counties in Iowa, which did not issue a stay-at-home order, with cases in border counties in Illinois, which did issue a stay-at-home order. Design, Setting, and Participants: This cross-sectional study with a difference-in-differences design compared daily changes in COVID-19 cases per 10 000 residents in 8 Iowa counties bordering Illinois with those in the 7 Illinois counties bordering Iowa before and after Illinois issued a stay-at-home order on March 21, 2020. Additional sensitivity analyses were conducted to account for differences in timing of closing schools and nonessential businesses between the 2 states and differential trends in COVID-19 cases by county population density and poverty rates. Exposures: Issuing a stay-at-home order. Main Outcomes and Measures: Comparison of cumulative cases of COVID-19 per 10 000 residents in border counties in Iowa and Illinois. Results: The total populations were 462 445 in the Iowa border counties and 272 385 in the Illinois border counties. Population density was higher in the Iowa counties (114.2 people per square mile) than in the Illinois counties (78.2 people per square mile). Trends of cumulative COVID-19 cases per 10 000 residents for the Iowa and Illinois border counties were comparable before the Illinois stay-at-home order, which went into effect at 5:00 pm on March 21 (March 15 to March 21: 0.024 per 10 000 residents vs 0.026 per 10 000 residents). After that, cases increased more quickly in Iowa and more slowly in Illinois. Within 10, 20, and 30 days after the enactment of the stay-at-home order in Illinois, the difference in cases was -0.51 per 10 000 residents (SE, 0.09; 95% CI, -0.69 to -0.32; P < .001), -1.15 per 10 000 residents (SE, 0.49; 95% CI, -2.12 to -0.18; P = .02), and -4.71 per 10 000 residents (SE, 1.99; 95% CI, -8.64 to -0.78; P = .02), respectively. The estimates indicate excess cases in the border Iowa counties by as many as 217 cases after 1 month without a stay-at-home order. This estimate of excess cases represents 30.4% of the 716 total cases in those Iowa counties by that date. Sensitivity analyses addressing differences in timing of closing schools and nonessential businesses and differences in county population density and poverty rates between the 2 states supported these findings. Conclusions and Relevance: This cross-sectional study with a difference-in-differences design found an increase in estimated rates of COVID-19 cases per 10 000 residents in the border counties in Iowa compared with the border counties in Illinois following a stay-at-home order that was implemented in Illinois but not in Iowa. SN - 2574-3805 UR - https://www.unboundmedicine.com/medline/citation/32413112/Comparison_of_Estimated_Rates_of_Coronavirus_Disease_2019__COVID_19__in_Border_Counties_in_Iowa_Without_a_Stay_at_Home_Order_and_Border_Counties_in_Illinois_With_a_Stay_at_Home_Order_ L2 - https://jamanetwork.com/journals/jamanetworkopen/fullarticle/10.1001/jamanetworkopen.2020.11102 DB - PRIME DP - Unbound Medicine ER -