Association Between Population Mobility Reductions and New COVID-19 Diagnoses in the United States Along the Urban–Rural Gradient, February–April, 2020

Xiaojiang Li, PhD, MS; Abby E. Rudolph, MPH, PhD; Jeremy Mennis, MS, PhD


Prev Chronic Dis. 2020;17(10):e118 

In This Article


We plotted the spatial distributions of the correlation coefficients and attendant catplots for each location type. The maps show that retail and recreation, grocery and pharmacy, parks, transit stations, and workplaces generally have significant and positive correlations — a decrease in visits to these locations is associated with a reduced rate of new COVID-19 cases 11 days later. Conversely, an increase in the amount of time spent in residential locations was significantly negatively correlated with an increase in the rate of new COVID-19 diagnoses in most observed counties — staying at home is associated with a slowed growth rate.

Geographic variation is substantial, however, where, in many rural counties, the correlation is not significant. This is illustrated further by the catplots, where for all location types, significant correlations are more likely to occur in urban counties. Indeed, most noncore counties (the most rural) show no significant correlations between change in mobility and the rate of new diagnoses, whereas most large central metropolitan counties show significant correlations for all location types (except parks). Results using the 5-day time lag were consistent with the results presented here.

We acknowledge certain limitations, including extensive missing county mobility data, and that other factors can influence disease transmission and reported cases (eg, testing practices, disease burden, population density, prevalence of chronic health conditions, age distributions, the population living in congregate settings). Additionally, these results reflect cases detected in the United States between February and April, when most states and counties had a combination of stay-at-home directives and business/school closures, and when cases were concentrated in a few urban areas, particularly New York City. In a post-hoc analysis we repeated the analysis by using a February 15 through June 19, 2020, study period. The resulting analogous urban–rural graphs for workplaces and residential places show that the association of mobility reductions with COVID-19 cases we observed for the initial study period dissipates to some extent, particularly in more rural areas (Figure). Notably, May 2020 was a period of decline in COVID-19 cases in the United States; the initial disease hotspots were cooling, and many states began to phase out mobility-reducing directives. This was followed in June by a rapid increase in COVID-19 cases in Florida, Arizona, and other states that did not act aggressively to reduce mobility and encourage wearing masks, with some states reinstating mobility reduction directives in response.


Post-hoc analysis of correlation between change in mobility and percentage increase in new COVID-19 cases 11 days later for February 15 through June 19, 2020, by US county. Correlations are shown for visits to workplaces and residential places and plotted within 6 different urban–rural classifications. Mobility data are from the Google Community Mobility Report, and confirmed COVID-19 case data are from the New York Times, Inc, Urban–rural classification data are from the National Center for Health Statistics. Significance is P < .05. The extended study period shows that the association between mobility change and new COVID-19 cases weakened somewhat as compared to the initial study period, particularly in more rural counties, reflecting the changing geographic pattern of disease dynamics occurring in May and June 2020. Abbreviation: metro, metropolitan.