Social vulnerability and county stay-at-home behavior during COVID-19 stay-at-home orders, United States, April 7–April 20, 2020

• DOI: 10.1016/j.annepidem.2021.08.020
• Publication Date: 2021-09-06T05:42:25Z
• Authors: Kelly M. Fletcher; Julie Espey; Marissa K. Grossman; J. Danielle Sharpe; Frank C. Curriero; Grete E. Wilt; Gregory Sunshine; Amanda Moreland; Mara Howard-Williams; J. Gabriel Ramos; Danilo Giuffrida; Macarena C. García; William M. Hartnett; Stephanie Foster
• Keywords: 03 medical and health sciences; COVID-19 Vaccines; 0302 clinical medicine; SARS-CoV-2; 1. No poverty; COVID-19; Humans; Original Article; United States; 3. Good health

Early COVID-19 mitigation relied on people staying home except for essential trips. The ability to stay home may differ by sociodemographic factors. We analyzed how factors related to social vulnerability impact a community's ability to stay home during a stay-at-home order.Using generalized, linear mixed models stratified by stay-at-home order (mandatory or not mandatory), we analyzed county-level stay-at-home behavior (inferred from mobile devices) during a period when a majority of United States counties had stay-at-home orders (April 7-April 20, 2020) with the Centers for Disease Control and Prevention Social Vulnerability Index (CDC SVI).Counties with higher percentages of single-parent households, mobile homes, and persons with lower educational attainment were associated with lower stay-at-home behavior compared with counties with lower respective percentages. Counties with higher unemployment, higher percentages of limited-English-language speakers, and more multi-unit housing were associated with increases in stay-at-home behavior compared with counties with lower respective percentages. Stronger effects were found in counties with mandatory orders.Sociodemographic factors impact a community's ability to stay home during COVID-19 stay-at-home orders. Communities with higher social vulnerability may have more essential workers without work-from-home options or fewer resources to stay home for extended periods, which may increase risk for COVID-19. Results are useful for tailoring messaging, COVID-19 vaccine delivery, and public health responses to future outbreaks.