Rural-urban outcome differences associated with COVID-19 hospitalizations in North Carolina

Area of Science:

• Public Health
• Epidemiology
• Health Disparities

Background:

• Rural populations in the U.S. face unique health challenges.
• These challenges may exacerbate risks during pandemics like COVID-19.
• Limited research exists on rurality and mortality risk in hospitalized COVID-19 patients.

Purpose of the Study:

• To investigate the association between rurality and mortality risk among hospitalized patients with COVID-19.
• To determine if living in a rural area increases the odds of death or hospice discharge after SARS-CoV-2 infection.

Main Methods:

• Retrospective cohort study of 3,991 patients hospitalized with SARS-CoV-2 infection in North Carolina.
• Data collected from March 1 to September 30, 2020.
• Logistic regression analysis to assess the association between rurality and a composite outcome of death/hospice discharge, adjusting for various demographic and clinical factors.

Main Results:

• Rural patients had a higher prevalence of comorbidities compared to urban patients.
• 16.5% of rural patients died or were discharged to hospice, versus 13.3% of urban patients.
• Rurality was associated with increased odds of death/hospice discharge (unadjusted OR 1.3; adjusted OR 1.2).

Conclusions:

• This study demonstrates a significantly higher COVID-19 mortality risk for rural residents in North Carolina.
• Addressing health disparities in rural areas is crucial for mitigating pandemic-related risks.
• Policy interventions may be necessary to reduce these observed disparities.