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Variation in Health Care Resources in Rural and Urban Counties Associated with Differences in COVID-19 Mortality
Journal of Health Care for the Poor and Underserved
|June 15, 2026
Summary
Rural counties with higher COVID-19 mortality had significant disparities in sociodemographics, lower vaccination rates, and reduced healthcare access and workforce compared to low-mortality counties.
Area of Science:
- Public Health
- Epidemiology
- Health Services Research
Background:
- Limited research exists on the impact of healthcare infrastructure and workforce variations on COVID-19 mortality in rural U.S. counties.
- Understanding these disparities is crucial for developing targeted public health interventions.
Purpose of the Study:
- To compare sociodemographics, vaccination status, healthcare access, and workforce supply between high- and low-mortality rural and urban counties.
- To identify factors contributing to elevated COVID-19 mortality in rural areas.
Main Methods:
- Stratified 1,548 rural and 1,148 urban U.S. counties based on 2021 COVID-19 median mortality rates (per 10,000 population).
- Compared sociodemographic characteristics, vaccination coverage, availability of health centers/hospitals, and healthcare workforce density.
- Utilized linked national datasets for comprehensive analysis.
Main Results:
- High-mortality rural counties exhibited higher proportions of older, minority, less educated, impoverished, and uninsured residents.
- These counties also had the lowest rates of complete COVID-19 vaccination.
- Access to hospitals, virtual services, and healthcare personnel, including advanced-practice registered nurses, was significantly lower in high-mortality rural areas.
Conclusions:
- Significant healthcare disparities exist in rural counties with high COVID-19 mortality.
- Targeted health policies and resource allocation are essential to address these gaps in rural communities.
- Addressing socioeconomic factors, vaccination coverage, and healthcare infrastructure is vital for mitigating rural COVID-19 mortality.
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