ArticleSocial science & medicine (1982)2023
Explaining the U.S. rural disadvantage in COVID-19 case and death rates during the Delta-Omicron surge: The role of politics, vaccinations, population health, and social determinants.
Article in Social science & medicine (1982), 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers, 1 of them a synthesis that pooled it.
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Who cites it
20 citing papers in PubMed, 1 synthesis or guideline pooled it, 22 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
- Rural and Urban Differences in the Trends in Supply of Home Care Workers From 2015 to 2024.Journal of applied gerontology : the official journal of the Southern Gerontological Society · 2026Article
- [Social determinants and COVID-19 mortality: Systematic review of the role of primary care].Atencion primaria · 2026Article
- Long COVID and Subjective Wellbeing among U.S. Working-Age Adults.Research square · 2026Article
- Features of the land use and COVID-19 cases and deaths in urban and land counties in Poland throughout the pandemic: a machine learning approach.BMC public health · 2026Article
- Dual pandemic of firearm injury and COVID-19 in Central and Southeastern Ohio: An interrupted time series analysis.PloS one · 2026Article
- Higher mortality following SARS-CoV-2 infection in rural versus urban dwellers persists for two years post-infection.Nature communications · 2025Article
- Stability and Volatility in the Contextual Predictors of Working-Age Mortality in the United States.Journal of health and social behavior · 2025Article
- Rural-Urban Disparities in COVID-19 Vaccine Uptake and Associated Mortality and Cardiovascular Disease Outcomes in the United States.Vaccines · 2025Review
- Life Expectancy and Health Expectancy in the Twenty-first Century: The Unthinkable, the Inconceivable, and the Unknowable.Demography · 2025Article
- Early detection of emerging SARS-CoV-2 Variants from wastewater through genome sequencing and machine learning.Nature communications · 2025Article
- The role of place-based consciousness in COVID-19 vaccine hesitancy: A survey analysis across rural and urban subgroups in the U.S.Social science & medicine (1982) · 2025Article
- Variability of COVID-19 mortality in Honduras: influence of sociodemographic factors.International journal for equity in health · 2025Article
- Broadband internet access as a social determinant of health in the early COVID-19 pandemic in U.S. counties.SSM - population health · 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
- U.S. Rural Population Health and Aging in the 2020s.The Public policy and aging report · 2025Review
- Article
- Deciphering the link between healthcare expenditure, corruption, and COVID-19 mortality.Scientific reports · 2024Article
- Disparities in All-Cause Mortality Beyond the Acute Phase of the COVID-19 Pandemic in the US.JAMA network open · 2024Article
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Authors and funding
4 authors at 2 institutions in 1 country.
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Abstract
The Delta-Omicron wave of the COVID-19 pandemic (Wave 4) in the United States occurred in Fall of 2021 through Spring of 2022. Although vaccinations were widely available, this was the deadliest period to date in the U.S., and the toll was especially high in rural areas, exacerbating an existing rural mortality penalty. This paper uses county-level multilevel regression models and publicly available data for 47 U.S. states and the District of Columbia. We describe differences in COVID-19 case and mortality rates across the rural-urban continuum during Wave 4 of the COVID-19 pandemic. Using a progressive modeling approach, we evaluate the relative contribution of a range of explanatory factors for the rural disadvantage we observe, including: pre-pandemic population health composition, vaccination rates, political partisanship, socioeconomic composition, access to broadband internet rate, and primary care physicians per capita. Results show that rural counties had higher observed burdens of cases and deaths in Wave 4 compared to more urban counties. The most remote rural counties had Wave 4 COVID-19 mortality rates 52% higher than the most urban counties. Older age composition, worse pre-pandemic population health, lower vaccination rates, higher share of votes cast for Donald Trump in the 2020 Presidential election, and lower socioeconomic composition completely explained the rural disadvantage in reported COVID-19 case rates in Wave 4, and accounting for these factors reversed the observed rural disadvantage in COVID-19 mortality. In models of mortality rate, Trump vote share had the largest effect size, followed by the percentage of the population age 50 or older, the poverty rate, the pre-pandemic mortality rate, the share of residents with a 4-year college degree, and the vaccination rate. These findings add to a growing literature describing the disproportionate toll of the COVID-19 pandemic on rural America, highlighting the combined effect of multiple sources of rural disadvantage.
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