Religion in Shaping Public Health During the COVID-19 Pandemic Across US Counties

Abstract

Public health outcomes are shaped by social and cultural factors, including religion. In the USA, where religious adherence is widespread, these beliefs may influence health behaviors. This study examines county-level associations between religious adherence and COVID-19 vaccination and mortality using hot spot analysis, ordinary least squares (OLS), and multiscale geographically weighted regression (MGWR) in ArcGIS Pro, while accounting for key demographic controls. Results show that the relationship between religion and COVID-19 outcomes is highly localized and context dependent, showing no consistent national pattern. A similar context-specific pattern is observed for income and poverty, whose effects vary across regions and local environments. In contrast, race, education, and gender demonstrate robust and consistent associations with COVID-19 outcomes at the national level. Interpreted through the lens of health behavior models, higher educational attainment is strongly linked to increased vaccine uptake and reduced mortality, underscoring education’s protective determinant, reinforcing its central role in enhancing health literacy and promoting adherence to public health measures. These findings highlight the importance of distinguishing between locally contingent influences and structural determinants when evaluating health disparities. This also carries theoretical significance by emphasizing the multi-level nature of health determinants, which operate at the local (religion, poverty), regional (income), and national (race, education) scales. Addressing these disparities requires a comprehensive, multi-dimensional approach from those responsible for public health decision-making.

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Society

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