(F) Rural-Urban Disparities in COVID-19 Related Mortality Across US Counties by Racial and Ethnic Composition

Sunday, August 28, 2022

8:00 AM – 6:00 PM CEST

Location: Hall E South

Publication Number: 1005

Presenting Author(s)

Wenxi Huang, MS
– sTUDENT, University of Florida, Gainesville, Florida, United States

Co-Author(s)

Inmaculada Hernandez
– UCSD, United States
Shangbin Tang
– University of Pittsburgh, United States
Nico Gabriel
– UCSD, United States
Nasser Sharareh, Ph.D.
– Research Assistant Professor, University of Utah, UT, United States
Nimish Patel
– UCSD, United States
Lucas A. Berenbrok, PharmD, MS
– Associate Professor, University of Pittsburgh School of Pharmacy, Pittsburgh, PA, United States
Sean Dickson
– West Health Policy Center, United States
Serena Jingchuan Guo, MP PhD
– Assistant Professor, University of Florida Department of Pharmaceutical Outcomes and Policy, University of Florida , Gainesville, Florida, United States

Background: The racial disparities for COVID-19 mortality in rural areas in the COVID-19 vaccine era may reflect structural inequities with lower healthcare access for racial and ethnic minority rural residents.

Objectives: The Coronavirus Disease 2019 (COVID-19) pandemic has had a devastating public health impact, but anti-SARS-CoV-2 vaccines can effectively lower the risk of COVID-19 and associated adverse health outcomes. In this study, we aimed to quantify rural-urban disparities in COVID-19-related mortality across US counties in the months following the availability of the anti-SARS-CoV-2 vaccines.

Methods: US counties were classified into rural vs. urban based on the US Department of Agriculture rural-urban continuum codes. We extracted county level information on racial and ethinic composition from University of Wisconsin’s County Health Rankings Data.
The study outcome was county-level COVID-19-related mortality, measured after anti-SARS-CoV-2 vaccines became publicly available (05/01/2021-11/30/2021), and was obtained from Johns Hopkins Coronavirus Resource Center. We constructed county-level Poisson regressions to examine the association between the rural classification and COVID-19 related mortality, controlling for county-level COVID-19 infection rate and sociodemographics (i.e., racial/ethnic composition, proportion with college education, female, unemployed, uninsured, and median household income). In the adjusted model, we tested the interaction effect between rural classification and racial/ethnic composition.

Results: In the adjusted model, rural counties, compared to urban counties, were associated with a greater risk of COVID-19 related mortality (incidence rate ratio [IRR] = 1.08 [95%CI 1.06-1.11]). We identified a significant interaction effect between the rural classification and racial composition of a county (p-value for the interaction <.001). Specifically, residing in a rural county was associated with a greater risk for COVID-19 related mortality in counties in the top 20% of Black composition (IRR=1.19 [1.13-1.24]) than in the bottom 80% (IRR=1.07[1.04-1.09]). A similar interaction was detected for the proportion of Hispanic population (p-value for in the interaction <.001): residing in a rural county was a stronger risk factor for COVID-19 mortality in counties in the top 20% of Hispanic composition (IRR=1.47 [1.40-1.55]) than in the bottom 80% (IRR=1.05 [1.02-1.07]).

Conclusions: Compared to urban counties, residents of rural counties experience higher COVID-19 related mortality. The increased mortality risk associated with living in a rural region was particularly pronounced in counties with larger Black and Hispanic populations.