ArticleThe Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association2023
Higher hospitalization and mortality rates among SARS-CoV-2-infected persons in rural America.
Article in The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 36 papers, 1 of them a synthesis that pooled it.
What it found
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
36 citing papers in PubMed, 1 synthesis or guideline pooled it, 40 citations in OpenAlex.
- Urban and Rural Disparities in COVID-19 Outcomes in the United States: A Systematic Review.Medical care research and review : MCRR · 2025Pooled it
- Disaggregating Middle Eastern and North African Populations in Mortality Records to Better Understand COVID-19 Inequalities in Virginia.Journal of racial and ethnic health disparities · 2026Article
- Risk factors for mechanical ventilation and mortality among hospitalized Medicaid patients with COVID-19 in Kentucky, 2020-2021.Scientific reports · 2026Article
- Inequalities and changes in mortality from leading causes in pre-pandemic and during COVID-19 pandemic in Lithuania.Population health metrics · 2026Article
- A case-crossover analysis of short-term PMCommunications medicine · 2025Article
- Higher mortality following SARS-CoV-2 infection in rural versus urban dwellers persists for two years post-infection.Nature communications · 2025Article
- Rural-Urban Disparities in COVID-19 Vaccine Uptake and Associated Mortality and Cardiovascular Disease Outcomes in the United States.Vaccines · 2025Review
- Identifying People Living With or Those at Risk for HIV in a Nationally Sampled Electronic Health Record Repository Called the National Clinical Cohort Collaborative: Computational Phenotyping Study.JMIR medical informatics · 2025Article
- Reflections of rural primary care physicians on the impact of the COVID-19 pandemic: a qualitative study.BMC primary care · 2025Article
- Equivalent Disease-Specific Survival Between Rural and Urban Osteosarcoma Patients: A Retrospective Analysis of the SEER Database.Current oncology (Toronto, Ont.) · 2025Article
- Long-Term Mortality Following SARS-CoV-2 Infection in Rural Versus Urban Dwellers With Autoimmune or Inflammatory Rheumatic Disease: A Retrospective Cohort Analysis From the National COVID Cohort Collaborative.Arthritis care & research · 2025Article
- Building a collaborative ecosystem across the IDeA-CTR networks in response to a public health emergency.Journal of clinical and translational science · 2025Article
- Associations between COVID-19 therapies and outcomes in rural and urban America: A multisite, temporal analysis from the Alpha to Omicron SARS-CoV-2 variants.The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association · 2025Article
- Vaccination status and disease severity of COVID-19 in different phases of the pandemic.Human vaccines & immunotherapeutics · 2024Article
- Prediction models for COVID-19 disease outcomes.Emerging microbes & infections · 2024Article
- Review
- COVID-19 mortality: educational inequalities and socio-spatial context in two provinces of Argentina.Revista peruana de medicina experimental y salud publica · 2024Article
- The rural mortality penalty in U.S. hospital patients with COVID-19.Population health metrics · 2024Article
- Effects of rurality and distance to care on perinatal outcomes over a 1-year period during the COVID-19 pandemic.The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association · 2024Article
- Rural-urban Differences in Long-term Mortality and Readmission Following COVID-19 Hospitalization, 2020 to 2023.Open forum infectious diseases · 2024Article
Corrections and comments
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Authors and funding
14 authors at 9 institutions in 1 country.
Funding
Abstract
purposeRural communities are among the most underserved and resource-scarce populations in the United States. However, there are limited data on COVID-19 outcomes in rural America. This study aims to compare hospitalization rates and inpatient mortality among SARS-CoV-2-infected persons stratified by residential rurality.
methodsThis retrospective cohort study from the National COVID Cohort Collaborative (N3C) assesses 1,033,229 patients from 44 US hospital systems diagnosed with SARS-CoV-2 infection between January 2020 and June 2021. Primary outcomes were hospitalization and all-cause inpatient mortality. Secondary outcomes were utilization of supplemental oxygen, invasive mechanical ventilation, vasopressor support, extracorporeal membrane oxygenation, and incidence of major adverse cardiovascular events or hospital readmission. The analytic approach estimates 90-day survival in hospitalized patients and associations between rurality, hospitalization, and inpatient adverse events while controlling for major risk factors using Kaplan-Meier survival estimates and mixed-effects logistic regression.
findingsOf 1,033,229 diagnosed COVID-19 patients included, 186,882 required hospitalization. After adjusting for demographic differences and comorbidities, urban-adjacent and nonurban-adjacent rural dwellers with COVID-19 were more likely to be hospitalized (adjusted odds ratio [aOR] 1.18, 95% confidence interval [CI], 1.16-1.21 and aOR 1.29, CI 1.24-1.1.34) and to die or be transferred to hospice (aOR 1.36, CI 1.29-1.43 and 1.37, CI 1.26-1.50), respectively. All secondary outcomes were more likely among rural patients.
conclusionsHospitalization, inpatient mortality, and other adverse outcomes are higher among rural persons with COVID-19, even after adjusting for demographic differences and comorbidities. Further research is needed to understand the factors that drive health disparities in rural populations.
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Registered trials
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