Community Susceptibility and Resiliency to COVID‐19 Across the Rural‐Urban Continuum in the United States

Abstract

This study creates a COVID-19 susceptibility scale at the county level, describes its components, and then assesses the health and socioeconomic resiliency of susceptible places across the rural-urban continuum. Methods:Factor analysis grouped 11 indicators into 7 distinct susceptibility factors for 3,079 counties in the conterminous United States. Unconditional mean differences are assessed using a multivariate general linear model. Data from 2018 are primarily taken from the US Census Bureau and CDC.Results: About 33% of rural counties are highly susceptible to COVID-19, driven by older and health-compromised populations, and care facilities for the elderly. Major vulnerabilities in rural counties include fewer physicians, lack of mental health services, higher disability, and more uninsured. Poor Internet access limits telemedicine. Lack of social capital and social services may hinder local pandemic recovery. Meat processing facilities drive risk in micropolitan counties. Although metropolitan counties are less susceptible due to healthier and younger populations, about 6% are at risk due to community spread from dense populations. Metropolitan vulnerabilities include minorities at higher health and diabetes risk, language barriers, being a transportation hub that helps spread infection, and acute housing distress. Conclusions:There is an immediate need to know specific types of susceptibilities and vulnerabilities ahead of time to allow local and state health officials to plan and allocate resources accordingly. In rural areas it is essential to shelterin-place vulnerable populations, whereas in large metropolitan areas general closure orders are needed to stop community spread. Pandemic response plans should address vulnerabilities.

COVID-19 incidence and mortality in the Metropolitan Region, Chile: time, space, and structural factors

“…Second, as long as different models are required to tell different stories (34 estimations in this case), a significant part of the municipal variation in infections and deaths can be explained by a rather small number of variables (as inTable 5). In any case, all the results highlight the role of social determinants of health in explaining the dissimilar impact of COVID-19 in the MR as well as other findings in other countries about unequal distribution of COVID-19(83)(84)(85)(86).…”

Síndrome respiratória aguda grave por COVID-19 em crianças e adolescentes no Brasil: perfil dos óbitos e letalidade hospitalar até a 38ᵃ Semana Epidemiológica de 2020

“…On the other hand, greater lethality among those living in rural areas may be a warning of COVID-19 gaining strength in rural areas, 19 given the vulnerabilities of population groups in rural communities, such as poorer access to health services. 20 Greater hospital lethality occurred in the Northeast and North regions, which also had the highest overall COVID-19 mortality rates. 21 In September 2020, the Northeast and the North recorded rates of 68.1 and 80.5 deaths per 100,000 inhabitants, respectively.…”

Analyzing the spatial determinants of local Covid-19 transmission in the United States

“…Some recent studies suggest that this transition may already be occurring ( Paul et al, 2020 ). This is problematic because individuals in rural locales are more likely to be older, lack health insurance, and have pre-existing medical conditions that increase their risk ( Peters, 2020 ; Razzaghi et al, 2020 ). Due to fewer ventilators, beds, and employees, medical facilities in rural counties are less equipped to handle surges in cases ( Kaufman et al, 2020 ).…”