The trend of the cumulative confirmed cases varied greatly in counties of the United States. We used the partitioning around medoids (PAM) clustering algorithm [12, 13] to assign counties with similar trends into a homogenous class after standardizing the time series of cumulative confirmed cases from March 1 to August 27, 2020. Based on the clustering results, we used the Kruskal–Wallis test [14] to detect whether there were significant differences in the distributions of 12 risk factors across different classes of counties. The 12 risk factors were used to build a negative binomial model [15, 16] for every class of the counties. The analysis was conducted in R version 3.6.1. This is an open source statistical analysis software available from R project https://cloud.r-project.org/.

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