Disparities in COVID-19 Mortality Rates: Implications for Rural Health Policy and Preparedness

Area of Science:

• Public Health
• Epidemiology
• Rural Health

Background:

• Rural communities face significant geographic and socioeconomic challenges, leading to health disparities.
• The specific impact of the coronavirus disease 2019 (COVID-19) pandemic on these communities remains less understood.

Purpose of the Study:

• To assess the impact of COVID-19 on rural Tennessee communities.
• To compare rural and urban COVID-19 mortality rates, adjusting for confounding factors.
• To inform state-level pandemic response policies for rural populations.

Main Methods:

• A cross-sectional analysis of cumulative COVID-19 mortality data from March 2020 to January 2021 in Tennessee counties.
• Data on sociodemographic factors, healthcare access, and comorbidities were integrated.
• Negative binomial regression was used to estimate adjusted incidence rate ratios for rural versus urban mortality.

Main Results:

• A total of 9,650 COVID-19 deaths were recorded across 95 counties (42 urban, 53 rural).
• After adjusting for sociodemographic characteristics, healthcare access, and comorbidities, rural counties had a 13% higher COVID-19 mortality rate (IRR=1.13, 95% CI, 1.00-1.28).
• The unadjusted COVID-19 mortality risk difference between rural and urban counties was substantially greater than the 5-year average risk difference for influenza and pneumonia.

Conclusions:

• Populations in rural Tennessee experienced higher COVID-19 mortality rates than their urban counterparts during the study period.
• These findings underscore the differential impact of the pandemic on rural populations.
• Public health decision-making must consider these disparities to effectively mitigate COVID-19 in rural areas.