BACKGROUND: Understanding the epidemiology of SARS-CoV-2 is essential for public health control efforts . Social, demographic, and political characteristics at the US county level might be associated with changes in SARS-CoV-2 case incidence .
METHODS: We conducted a retrospective analysis of the relationship between the change in reported SARS-CoV-2 case counts at the US county level during June 1 , 2020 - June 30,2020 and social, demographic, and political characteristics of the county .
RESULTS: 1023/3142 US counties were included in the analysis . 678 (66·3 %) had increasing, and 345 (33·7 %) had non-increasing SARS-CoV-2 case counts between June 1 - June 30 , 2020 . In bivariate analysis, counties with increasing case counts had significantly higher Social Deprivation Index (median 48, IQR 24 - 72) than counties with non-increasing case counts (median 40, IQR 19 - 66; p=0·009). Counties with increasing case counts were significantly more likely to be metropolitan areas of 250,000 - 1 million population (p & 0·001), to have a higher percentage of Black residents (9% vs. 6%, p=0·013), and to have voted for the Republican presidential candidate in 2016 by a 10-point or greater margin (p=0·044). In the multivariable model, metropolitan areas of 250,000 - 1 million population, higher percentage of Black residents and a 10-point or greater Republican victory were independently associated with increasing case counts .
CONCLUSIONS: Increasing case counts of SARS-CoV-2 in the US during June 2020 were associated with a combination of sociodemographic and political factors . Addressing social disadvantage and differential belief systems that may correspond with political alignment will play a critical role in pandemic control.