COVID More Severe in Rural Areas

The National COVID Cohort Collaborative (N3C) within NIH, reveals how the pandemic has widened the gap between rural and urban health outcomes.

Rural health researchers have examined N3C patient health records from every state representing 44 health systems, between January 2020 and June 2021.

They compared COVID related hospitalizations and morality rates for people in rural areas to people in urban areas. The N3C data included information on 1,033,329 people diagnosed with COVID including 186,882 people hospitalized with COVID.

Given the lack of prior SARS-CoV-2 exposure in rural and urban populations alike, investigators expected to see similar health outcomes across communities. What they found was just the opposite.

Even after adjusting for demographic differences and comorbidities, people with COVID in rural areas were significantly more likely than those in urban areas to be hospitalized. In rural communities near urban areas, people with COVID were 18% more likely to be in urban areas and be hospitalized then those who lived far from urban areas as they were 29% more likely to be hospitalized.

Mortality rates showed an even sharper disparity. After adjustments, rural residents no matter how near they lived to urban areas were about 36% more likely than urban residents to die within 90 days after COVID hospitalization. The researchers say that the findings call for a closer look at the role that issues such as care delays and environmental risk factors may play in having worse rural COVID outcomes.

According to Ali Khan M.D., Professor in the Department of Epidemiology, University of Nebraska Medical Center, “This study highlights the need for public health to better focus on disparities in COVID health outcomes among rural communities, including addressing prevention strategies such as increased vaccination.”

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