This policy brief examines spatial clusters of COVID-19 mortality rates across counties in the United States between December 2020 and January 2021. Between December 2020 and January 2021, COVID-19 deaths were at their peak, hospital capacity was stretched, and COVID-19 vaccines were not widely available, making this a critical time period to examine.

Key Findings:

• Spatial clusters of high COVID-19 mortality rates occurred in Iowa, South Dakota, Kansas, Pennsylvania, Texas, and Arizona.
• A higher percentage of clusters of high COVID-19 mortality rates were in noncore and micropolitan counties compared to metropolitan counties.
• High COVID-19 mortality cluster counties tended to have higher average percentages of Hispanic populations, particularly in micropolitan counties.
• Noncore counties that were high COVID-19 mortality clusters had the highest average nursing home bed density and the highest average proportion of Medicare beneficiaries with multiple chronic conditions.