Evidence map›Paper›PMID 41062502›Full record

ArticleNature communications2025

Higher mortality following SARS-CoV-2 infection in rural versus urban dwellers persists for two years post-infection.

A Jerrod Anzalone, Michael T Vest, Makayla E Schissel, Bradley Price, William B Hillegass, Ronald Horswell, San Chu, Clifford J Rosen, Lucio Miele, Susan L Santangelo and 3 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Nature communications, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed.

  1. Article
  2. Article
  3. Article
  4. Article
  5. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors.

A Jerrod AnzaloneUniversity of Nebraska Medical Center, Omaha, NE, USA. alfred.anzalone@unmc.edu.ORCID http://orcid.org/0000-0002-3212-7845
Michael T VestChristiana Care Health System, Newark, DE, USA.ORCID http://orcid.org/0000-0002-3525-6095
Makayla E SchisselUniversity of Nebraska Medical Center, Omaha, NE, USA.
Bradley PriceWest Virginia University, Morgantown, WV, USA.ORCID http://orcid.org/0000-0002-0619-3347
William B HillegassUniversity of Mississippi Medical Center, Jackson, MS, USA.
Ronald HorswellPennington Biomedical Research Center, Baton Rouge, LA, USA.
San ChuPennington Biomedical Research Center, Baton Rouge, LA, USA.ORCID http://orcid.org/0000-0003-3058-824X
Clifford J RosenMaineHealth Institute for Research, Scarborough, ME, USA.
Lucio MieleLouisiana State University Health Sciences Center, New Orleans, LA, USA.ORCID http://orcid.org/0000-0002-5853-7287
Susan L SantangeloMaineHealth Institute for Research, Scarborough, ME, USA.
Gordon S SmithWest Virginia University, Morgantown, WV, USA.ORCID http://orcid.org/0000-0002-2911-3071
Sally L HodderWest Virginia University, Morgantown, WV, USA.
National Clinical Cohort Collaborative (N3C) Consortium

Funding

University of Pittsburgh Clinical and Translational Science InstituteUL1TR001857 · NCATS · UNIVERSITY OF PITTSBURGH AT PITTSBURGH · PI REIS, STEVEN E · 2016 to 2025
$129.3M
UCLA Clinical Translational Science InstituteUL1TR001881 · NCATS · UNIVERSITY OF CALIFORNIA LOS ANGELES · PI ARLEEN F. BROWN, ARASH NAEIM · 2016 to 2026
$118.1M
Clinical and Translational Science InstituteUL1TR001872 · NCATS · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI COLLARD, HAROLD R, JACOBY, VANESSA · 2016 to 2025
$112.1M
Project-005UL1TR001445 · NCATS · NEW YORK UNIVERSITY SCHOOL OF MEDICINE · PI BREDELLA, MIRIAM ANTOINETTE, HOCHMAN, JUDITH S · 2015 to 2025
$103.5M
Yale Clinical and Translational Science Award (U Component)UL1TR001863 · NCATS · YALE UNIVERSITY · PI John H. Krystal, LUCILA OHNO-MACHADO · 2016 to 2026
$102.9M
Phenotypic Diversity in COVID-19UL1TR001878 · NCATS · UNIVERSITY OF PENNSYLVANIA · PI FITZGERALD, GARRET A · 2016 to 2025
$102.4M
Transform Dissemination and Implementation Science in CTSA ProgramsUL1TR002319 · NCATS · UNIVERSITY OF WASHINGTON · PI John K. Amory · 2017 to 2026
$100.0M
Clinical and Translational Science AwardUL1TR001873 · NCATS · COLUMBIA UNIVERSITY HEALTH SCIENCES · PI REILLY, MUREDACH P · 2016 to 2025
$99.0M
WU INSTITUTE OF CLINICAL AND TRANSLATIONAL SCIENCESUL1TR002345 · NCATS · WASHINGTON UNIVERSITY · PI William G. Powderly · 2017 to 2026
$97.8M
The Harvard Clinical and Translational Science CenterUL1TR002541 · NCATS · HARVARD MEDICAL SCHOOL · PI NADLER, LEE MARSHALL · 2018 to 2022
$93.0M
Implementing a Maternal health and PRegnancy Outcomes Vision for Everyone (IMPROVE)UL1TR002378 · NCATS · EMORY UNIVERSITY · PI Andres J Garcia, Elizabeth O. Ofili · 2017 to 2026
$92.1M
UC San Diego Clinical and Translational Research InstituteUL1TR001442 · NCATS · UNIVERSITY OF CALIFORNIA, SAN DIEGO · PI FIRESTEIN, GARY S, HOGARTH, MICHAEL · 2015 to 2024
$88.3M
Gates Foundation INV-018455NCATS NIH HHS U24 TR002306NCATS NIH HHS UL1 TR000460NCATS NIH HHS UL1 TR001409NCATS NIH HHS UL1 TR001412NCATS NIH HHS UL1 TR001414NCATS NIH HHS UL1 TR001420NCATS NIH HHS UL1 TR001422NCATS NIH HHS UL1 TR001425NCATS NIH HHS UL1 TR001427NCATS NIH HHS UL1 TR001430NCATS NIH HHS UL1 TR001433NCATS NIH HHS UL1 TR001436NCATS NIH HHS UL1 TR001439NCATS NIH HHS UL1 TR001442NCATS NIH HHS UL1 TR001445NCATS NIH HHS UL1 TR001449NCATS NIH HHS UL1 TR001450NCATS NIH HHS UL1 TR001453NCATS NIH HHS UL1 TR001855NCATS NIH HHS UL1 TR001857NCATS NIH HHS UL1 TR001860NCATS NIH HHS UL1 TR001863NCATS NIH HHS UL1 TR001866NCATS NIH HHS UL1 TR001872NCATS NIH HHS UL1 TR001873NCATS NIH HHS UL1 TR001876NCATS NIH HHS UL1 TR001878NCATS NIH HHS UL1 TR001881NCATS NIH HHS UL1 TR002003NCATS NIH HHS UL1 TR002014NCATS NIH HHS UL1 TR002240NCATS NIH HHS UL1 TR002319NCATS NIH HHS UL1 TR002345NCATS NIH HHS UL1 TR002369NCATS NIH HHS UL1 TR002373NCATS NIH HHS UL1 TR002378NCATS NIH HHS UL1 TR002384NCATS NIH HHS UL1 TR002389NCATS NIH HHS UL1 TR002489NCATS NIH HHS UL1 TR002494NCATS NIH HHS UL1 TR002529NCATS NIH HHS UL1 TR002535NCATS NIH HHS UL1 TR002537NCATS NIH HHS UL1 TR002538NCATS NIH HHS UL1 TR002541NCATS NIH HHS UL1 TR002544NCATS NIH HHS UL1 TR002548NCATS NIH HHS UL1 TR002550NCATS NIH HHS UL1 TR002553NCATS NIH HHS UL1 TR002556NCATS NIH HHS UL1 TR002645NCATS NIH HHS UL1 TR002649NCATS NIH HHS UL1 TR002733NCATS NIH HHS UL1 TR002736NCATS NIH HHS UL1 TR003015NCATS NIH HHS UL1 TR003017NCATS NIH HHS UL1 TR003096NCATS NIH HHS UL1 TR003098NCATS NIH HHS UL1 TR003107NCATS NIH HHS UL1 TR003142NCATS NIH HHS UL1 TR003167NCATS NIH HHS UM1 TR004406NCATS NIH HHS UM1 TR004528NCATS NIH HHS UM1 TR004556NIGMS NIH HHS U54 GM104938NIGMS NIH HHS U54 GM104940NIGMS NIH HHS U54 GM104941NIGMS NIH HHS U54 GM104942NIGMS NIH HHS U54 GM115371NIGMS NIH HHS U54 GM115428NIGMS NIH HHS U54 GM115458NIGMS NIH HHS U54 GM115516NIGMS NIH HHS U54 GM115677NIGMS NIH HHS U54 GM133807U.S. Department of Health & Human Services | NIH | National Institute of General Medical Sciences (NIGMS) U54GM115458
6 · The paper itself

Abstract

Previous studies demonstrated higher short-term mortality among rural compared with urban residents infected with SARS-CoV-2. However, whether this difference persists remains uncertain. This retrospective cohort study analyzed two-year post-COVID-19 mortality by rurality using the National Clinical Cohort Collaborative COVID-19 Enclave, a United States-based longitudinal electronic health record repository. We analyzed mortality among patients infected with SARS-CoV-2 between April 2020 and December 2022, with follow-up until December 2024. Patients were categorized into urban, urban-adjacent rural (UAR), and nonurban-adjacent rural (NAR) groups based on residential ZIP Code. Mortality differences were assessed using Kaplan-Meier analysis and weighted multivariable Cox regression, with weights derived from demographic factors and models adjusted for background clinical risk and social vulnerability. Among 3,082,978 SARS-CoV-2-infected patients, we found a significant association between rurality and increased two-year all-cause mortality post-infection. Adjusted hazards for two-year mortality for UAR and NAR were 1.19 (95% CI 1.18-1.21) and 1.26 (1.22-1.29). A reference cohort of 4,153,216 COVID-19-negative patients showed a modest yet consistent rural mortality penalty, with a similar relative hazard across cohorts, an observed rurality-COVID-19 interaction, and a greater absolute number of deaths following SARS-CoV-2 infection. Our findings emphasize ongoing rural mortality disparities and the importance of public health efforts in rural communities.

Indexed as

COVID-19Rural PopulationUrban PopulationAdultAgedAged, 80 and overFemaleHumansKaplan-Meier EstimateMaleMiddle AgedRetrospective StudiesRisk FactorsSARS-CoV-2United StatesYoung Adult

Identifiers

PMID41062502
PMCPMC12508022

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.