Rural-Urban and Within-Rural Differences in COVID-19 Mortality Rates

Abstract

Since late-2020, COVID-19 mortality rates have been higher in rural than in urban America, but there has also been substantial within-rural heterogeneity. Using data from USA Facts, we compare COVID-19 mortality trends between U.S. urban (nonmetro) and rural (metro) counties from March 2020 to May 2021. We then compare trends within rural counties across different types of labor markets defined by county economic dependence (farming, mining, manufacturing, government, recreation, and nonspecialized) and by metropolitan adjacency. As of May 22, 2021, the cumulative COVID-19 mortality rate was 199.3 per 100,000 population in rural counties compared to 175.8 in urban counties. Net of controls, rural counties experienced a 3% higher average daily increase in COVID-19 mortality rates than urban counties over the study period. Rural mortality rates have been highest in the South, Southwest, and Great Plains. Both overall and within rural counties, mortality rates were highest in farming-dependent counties and lowest in recreation-dependent counties. Interaction models demonstrate that the protective buffer for recreation counties was even stronger for remote rural counties (those not adjacent to metro areas.

Rural‐urban and within‐rural differences in COVID‐19 vaccination rates

“…Since late 2020, the cumulative COVID‐19 mortality rate has been higher in rural than in urban areas of the United States, 1 threatening to exacerbate the existing rural mortality penalty 2,3 . Achieving high vaccination coverage is the best way to prevent coronavirus spread, promote economic recovery, and save lives.…”

Rural-Urban Variation in COVID-19 Experiences and Impacts among U.S. Working-Age Adults

“…As with COVID-19 mortality itself (Cheng et al 2020;Cromartie et al 2020;Sun et al 2021), the mental health, social, and financial consequences of the pandemic have not been distributed equally across geography. My findings show that residents of rural counties that are adjacent to metro areas were more likely than their large urban peers to report worse outcomes on multiple measures, including testing positive for coronavirus, living with someone who tested positive, having a close friend or family member outside of the household test positive, having a close friend or family member hospitalized, seeking treatment for anxiety or depression, meeting the threshold for anxiety, and reporting that their relationships with friends or immediate family worsened.…”

“…Among rural counties, COVID-19 infection rates have been higher in those that are adjacent to metro areas compared to remote rural counties that do not neighbor a metro area (Cheng et al, 2020;Sun 2020;Zhang and Schwartz 2020). Other recent research shows that remoteness may have buffered certain types of rural communities, particularly those dominated by services and recreation based employment, from COVID-19 spread (Sun et al 2021). COVID-19 may have had spillover effects from urban to adjacent rural communities due to employee and consumer commuting patterns.…”

“…I also suggested that the longerterm health and economic impacts could be worse in rural than in urban areas. Since then, a growing body of research has shown higher cumulative COVID-19 infection and mortality rates in rural counties (Cromartie et al 2021;Huang et al 2021;Pender 2021;Sun et al 2021) but potentially less severe labor market impacts (Brooks et al 2021;Cho et al 2020;Cromartie et al 2021). However, rural areas are not homogenous, and there has also been significant within-rural variation in COVID-19 spread and mortality rates (Cheng et al 2020;Cohen 2020;Cromartie et al 2020;Sun et al 2021).…”

Rural-Urban Differences in the Associations Between Aging and Disability Services and COVID-19 Vaccination Rates Among Older Adults

“…In addition, COVID-19 vaccination rates are lagging in rural America ( Sun & Monnat, 2021 ; Tolbert et al, 2021 ). This is concerning because rural areas have larger relative shares of older adults, lower access to health care infrastructure, and higher COVID-19 mortality ( Putzer et al, 2012 ; Rogan & Lewis, 2020 ; Sun et al, 2022 ). Therefore, understanding if an association between older adult service density and older adult vaccination rates exists across rural and urban contexts has potentially useful policy implications for boosting older adult vaccination rates.…”