Half of Rural Residents at High Risk of Serious Illness Due to COVID‐19, Creating Stress on Rural Hospitals

Abstract

Purpose During the COVID‐19 epidemic, it is critical to understand how the need for hospital care in rural areas aligns with the capacity across states. Methods We analyzed data from the 2018 Behavioral Risk Factor Surveillance System to estimate the number of adults who have an elevated risk of serious illness if they are infected with coronavirus in metropolitan, micropolitan, and rural areas for each state. Study data included 430,949 survey responses representing over 255.2 million noninstitutionalized US adults. For data on hospital beds, aggregate survey data were linked to data from the 2017 Area Health Resource Files by state and metropolitan status. Findings About 50% of rural residents are at high risk for hospitalization and serious illness if they are infected with COVID‐19, compared to 46.9% and 40.0% in micropolitan and metropolitan areas, respectively. In 19 states, more than 50% of rural populations are at high risk for serious illness if infected. Rural residents will generate an estimated 10% more hospitalizations for COVID‐19 per capita than urban residents given equal infection rates. Conclusion More than half of rural residents are at increased risk of hospitalization and death if infected with COVID‐19. Experts expect COVID‐19 burden to outpace hospital capacity across the country, and rural areas are no exception. Policy makers need to consider supply chain modifications, regulatory changes, and financial assistance policies to assist rural communities in caring for people affected by COVID‐19.

Comparing Associations of State Reopening Strategies with COVID-19 Burden

“…However, mortality may be higher in rural states since older and rural residents are likely to experience greater burden of serious illness and mortality due to COVID-19. 17 Our results may be impacted by measurement error in the outcomes, as asymptomatic cases and out-of-hospital deaths Estimates for excess cases and deaths generated using average marginal effects to compare predicted cases with reopening (before and after implementing mask mandates) compared to not reopening at 6 weeks are likely to be underrepresented. In addition, the state-level data do not capture the variation in local policies, which may have contributed to the impact of reopening.…”

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

“…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 ). A subsequent analysis comparing the hospital and reclassified RUCA data revealed that hospitals in counties classified as rural had an average of 0.55 ventilators and 3.39 ICU beds per hospital, while counties classified as urban, micropolitan, and small town had an average of 3.66 ventilators and 14.42 ICU beds per hospital.…”

Rural Health Response and Community Preparedness for the Covid-19 Pandemic

“…During the Covid-19 pandemic, rural communities have the same risk as urban communities. Several studies stated that rural areas have a high risk of Covid-19 transmission 3,4 . Several factors include community characteristics, population mobilization, rural health capacity, government policies and behavior of rural communities as well as the resilience 3,5,6 .…”

“…A study in USA stated that the high incidence of Covid-19 in rural areas occurs because of the formation of immunity, symptomless diseases and the spreading of virus very easily and quickly. Hospitals in rural areas also experience a high burden in treating Covid-19 patients 4 . However, more attention is paid to the incidence cases in urban areas 3 .…”