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    Area of Science:

    • Public Health
    • Epidemiology
    • Rural Health Disparities

    Background:

    • Significant disparities in death rates exist between rural and urban areas in the United States, a trend that has widened over the past two decades.
    • In 2019, elevated mortality rates in rural regions were observed across all ten leading causes of death.
    • COVID-19 emerged as the third leading cause of death nationally in 2020.

    Purpose of the Study:

    • To analyze and present COVID-19 death rates in rural versus urban areas for the year 2020.
    • To examine these rates stratified by sex and age groups (under 65 and 65 and over).
    • To report rates across six distinct urbanicity categories based on decedent's county of residence.

    Main Methods:

    • Utilized national mortality data for 2020, focusing on COVID-19 as the cause of death.
    • Classified decedents into urban and rural categories based on county-level classifications (metropolitan, micropolitan, noncore).
    • Calculated and compared COVID-19 death rates across different demographic groups and urbanicity levels.

    Main Results:

    • COVID-19 death rates were higher in rural areas compared to urban areas in 2020.
    • Specific age and sex differentials in rural vs. urban COVID-19 mortality were observed.
    • Mortality varied across the six defined categories of urbanicity.

    Conclusions:

    • The findings underscore the disproportionate impact of the COVID-19 pandemic on rural populations.
    • Persistent rural health disadvantages are evident, exacerbated by the COVID-19 pandemic.
    • Targeted public health interventions may be necessary to address rural-urban disparities in infectious disease mortality.