ArticleThe Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association2021
The Association of Social Determinants of Health With COVID-19 Mortality in Rural and Urban Counties.
Article in The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 36 papers, 3 of them syntheses that pooled it.
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Who cites it
36 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- Exit Meta-Analysis on the Effect of HIV on COVID-19 Mortality, Hospitalization, and ICU Admission.Medical sciences (Basel, Switzerland) · 2025Pooled it
- Urban and Rural Disparities in COVID-19 Outcomes in the United States: A Systematic Review.Medical care research and review : MCRR · 2025Pooled it
- Significant association between HIV infection and increased risk of COVID-19 mortality: a meta-analysis based on adjusted effect estimates.Clinical and experimental medicine · 2023Pooled it
- Spatial accessibility to healthcare facilities and the cumulative incidence of COVID-19 infection: evidence from the reasons for geographic and racial differences in stroke (REGARDS) study, United States, March 2020 to September 2021.Preventive medicine reports · 2026Article
- Black and White disparity in U.S. female breast cancer mortality: a nationwide analysis, 1999-2023.Breast cancer research and treatment · 2026Article
- Mortality before and during the COVID-19 pandemic in Manhiça district, Southern Mozambique.Population health metrics · 2026Article
- Article
- Impact of COVID Pandemic on Financial Burdens in Metro and Non-Metro Regions: Findings from a Cross-Sectional Survey.Research square · 2025Article
- Article
- Health differences between rural and non-rural Texas counties based on 2023 County Health Rankings.BMC health services research · 2025Article
- Predicting mobile health clinic utilization for COVID-19 vaccination in South Carolina: A statistical framework for strategic resource allocation.PLOS global public health · 2025Article
- Mobile health clinics for distribution of vaccinations to underserved communities during health emergencies: A COVID-19 case study.Public health in practice (Oxford, England) · 2024Article
- Novel Characterization of Socioecological Determinants of Health in Rural Alabama.The Journal of surgical research · 2024Article
- Social-Economic Backgrounds to US County-Based COVID-19 Deaths: PLS-SEM Analysis.Journal of racial and ethnic health disparities · 2024Article
- Specialist care visits outside the hospital by South Australian older adults.BMC health services research · 2024Article
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- State variation in neighborhood COVID-19 burden across the United States.Communications medicine · 2024Article
- Article
- Article
- Community Engagement Alliance (CEAL): A National Institutes of Health Program to Advance Health Equity.American journal of public health · 2024Article
Corrections and comments
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Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeTo identify the county-level effects of social determinants of health (SDoH) on COVID-19 (corona virus disease 2019) mortality rates by rural-urban residence and estimate county-level exceedance probabilities for detecting clusters.
methodsThe county-level data on COVID-19 death counts as of October 23, 2020, were obtained from the Johns Hopkins University. SDoH data were collected from the County Health Ranking and Roadmaps, the US Department of Agriculture, and the Bureau of Labor Statistics. Semiparametric negative binomial regressions with expected counts based on standardized mortality rates as offset variables were fitted using integrated Laplace approximation. Bayesian significance was assessed by 95% credible intervals (CrI) of risk ratios (RR). County-level mortality hotspots were identified by exceedance probabilities.
findingsThe COVID-19 mortality rates per 100,000 were 65.43 for the urban and 50.78 for the rural counties. Percent of Blacks, HIV, and diabetes rates were significantly associated with higher mortality in rural and urban counties, whereas the unemployment rate (adjusted RR = 1.479, CrI = 1.171, 1.867) and residential segregation (adjusted RR = 1.034, CrI = 1.019, 1.050) were associated with increased mortality in urban counties. Counties with a higher percentage of college or associate degrees had lower COVID-19 mortality rates.
conclusionsSDoH plays an important role in explaining differential COVID-19 mortality rates and should be considered for resource allocations and policy decisions on operational needs for businesses and schools at county levels.
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