ArticleThe Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association2022
Rural-urban and within-rural differences in COVID-19 vaccination rates.
Article in The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 97 papers.
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Who cites it
97 citing papers in PubMed.
- Hesitancy and confidence in pediatric COVID-19 vaccination among diverse caregivers of unvaccinated children.Vaccine · 2025Trial
- Higher Human Papillomavirus Vaccination Coverage Among American Indian and Alaska Native Adolescents and Rural Adolescents in Alaska.Journal of community health · 2026Article
- Utilizing the CFIR to Evaluate Rural COVID-19 Vaccine Uptake: Extension Personnel Perspectives.Vaccines · 2026Article
- Acceptance of the COVID-19 Booster Vaccine Amid the Omicron JN.1 Surge in Southern Bangladesh: A Comparative Analysis of Rural-Urban Disparities.Risk analysis : an official publication of the Society for Risk Analysis · 2026Observational
- "You're Not Dealing with What We're Dealing with": COVID-19 Hesitancies and Motivations Among Late Vaccinating Black Americans in the Deep South.Journal of racial and ethnic health disparities · 2026Article
- Implementation evaluation of the COVID-19 vaccination: Speed, equity and mortality trends.African journal of primary health care & family medicine · 2026Article
- The Disproportionate Burden: Health and Economic Outcomes of COVID-19 for Native American Communities.Research square · 2026Article
- Applying machine learning to identify unrecognized COVID-19 deaths recorded as other causes of death in the United States.Science advances · 2026Article
- Article
- Bridging the gap: a review of the factors contributing to differences in vaccination coverage among rural and urban adults.Vaccine · 2026Review
- Adherence to COVID-19 vaccination in riverside populations of the municipality of Careiro/AM.Revista brasileira de enfermagem · 2026Observational
- Article
- Anticipated Protection Overcomes Vaccine Hesitancy and Mistrust Among Women Enrolled in the DC MACS/WIHS Combined Cohort Study.Journal of acquired immune deficiency syndromes (1999) · 2025Article
- Pre- and during -COVID-19 pandemic mortality trends and drivers in rural, coastal Kenya: findings from the Kaloleni-Rabai Health and Demographic Surveillance System.Population health metrics · 2025Review
- Long COVID Disproportionately Reported by Disadvantaged Individuals: A National Survey of U.S. Working-Age Adults.Journal of general internal medicine · 2025Article
- Variation in COVID-19 vaccination and adverse outcomes: a state of Georgia case study.BMC public health · 2025Article
- COVID-19 pandemic reclassification and implications for continuing uptake of COVID-19 vaccination: The case of Savannah Region, Ghana, 2023.IJID regions · 2025Article
- Sociodemographic Inequalities in COVID-19 Booster Dose Vaccination Coverage: a Retrospective Study of 196 Provinces in Peru.Journal of racial and ethnic health disparities · 2025Article
- Disparity between expected spatial accessibility and actual travel time to vaccination sites: Implications for COVID-19 immunization delays.SSM - population health · 2025Article
- A Canadian multi-province study of COVID-19 vaccine coverage along area-level social determinants in 2021.Public health in practice (Oxford, England) · 2025Article
37 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
2 authors.
Funding
Abstract
purposeCOVID-19 mortality rates are higher in rural versus urban areas in the United States, threatening to exacerbate the existing rural mortality penalty. To save lives and facilitate economic recovery, we must achieve widespread vaccination coverage. This study compared adult COVID-19 vaccination rates across the US rural-urban continuum and across different types of rural counties.
methodsWe retrieved vaccination rates as of August 11, 2021, for adults aged 18+ for the 2,869 counties for which data were available from the CDC. We merged these with county-level data on demographic and socioeconomic composition, health care infrastructure, 2020 Trump vote share, and USDA labor market type. We then used regression models to examine predictors of COVID-19 vaccination rates across the USDA's 9-category rural-urban continuum codes and separately within rural counties by labor market type.
findingsAs of August 11, 45.8% of adults in rural counties had been fully vaccinated, compared to 59.8% in urban counties. In unadjusted regression models, average rates declined monotonically with increasing rurality. Lower rural rates are explained by a combination of lower educational attainment and higher Trump vote share. Within rural counties, rates are lowest in farming and mining-dependent counties and highest in recreation-dependent counties, with differences explained by a combination of educational attainment, health care infrastructure, and Trump vote share.
conclusionLower vaccination rates in rural areas is concerning given higher rural COVID-19 mortality rates and recent surges in cases. At this point, mandates may be the most effective strategy for increasing vaccination rates.
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