COVID-19 Hospitalization and Mortality Significantly Higher for Rural Populations


Investigators saw vastly higher rates of hospitalization and mortality for rural populations over urban even after adjusting the results for various factors.


One IDWeek study identified rural communities as “among the most vulnerable and resource-scarce populations in the United States.” As such, investigators from the University of Nebraska Medical Center examined whether rural populations experience disproportionate COVID-19 hospitalization and mortality, when compared to urban populations.

Investigators used data provided by the National Cohort Collaborative (N3C) for their study, which was the first to research rural populations at this scale. The study selected a cohort of 573,018 patients presenting with COVID-19 from January 2020-March 2021. The cohort was selected from 27 hospital systems across the US with varying degrees of rurality.

The investigators used multivariate Cox regression analysis and mixed-effects models to gauge the association between rurality, hospitalization, and mortality of COVID-19 patients. The study controlled for the discrepancies between rural and urban risk factors and the respective health systems that could account for differences in mortality rates.

The results showed a statistically significant difference in COVID-19 hospitalization and mortality rates between urban, urban-adjacent rural (UAR), and nonurban-adjacent rural (NAR) areas. Hospitalizations for UAR were 1.41, p< 0.001, 95% CI: 1.37 – 1.45, and NAR 1.42, p< 0.001, 95% CI: 1.35 – 1.50, both far higher than for urban populations. All-cause mortality after COVID-19 diagnosis was similarly lower in urban areas, while UAR had 1.39, p< 0.001, 95% CI: 1.30 – 1.49, while NAR saw 1.38, p< 0.001, 95% CI: 1.22 – 1.55.

These large differences in higher rates of rural hospitalization and mortality persisted despite the investigators adjusting for BMI, comorbidity, gender, age, and quarter of diagnosis for COVID-19.

In addition to a vast disparity between regional COVID-19 hospitalization and mortality rates, this study found demographic and clinical differences within rural patients that the investigators recommended for further study.

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