Research Update: Why Coronavirus Could Hit Rural Areas Harder
Transmission rates may be lower in rural areas, the percentage of cases resulting in death and other serious complications could be higher in rural than in urban areas.
THE DAILY YONDER | By Shannon Monnat On Mar 24, 2020
As rates of coronavirus (COVID-19) infection and death continue to rise, it is important to consider how rural areas may be differentially affected. On the one hand, rural parts of the U.S. may be comparatively better off than urban places due to lower population density in rural areas. Lower population density reduces opportunities for virus spread. On the other hand, there are several features of rural populations and places that increase their risk of coronavirus-related mortality and other long-term health impacts.
These include the realities that rural populations are older and have higher rates of several chronic health conditions, and rural areas have a less robust health care infrastructure to deal with coronavirus cases. Rural economies may also be affected in different ways than their urban counterparts, which has implications for long-term rural population health outcomes.
Rural Populations Are Older
Coronavirus infection is more deadly for older adults. According to a recent CDC report, thus far, 31% of COVID-19 cases, 45% of hospitalizations, 53% of intensive care admissions, and 80% of deaths have been among adults aged 65 and older, with the highest percentage of severe outcomes among those 85 years and older. This is bad news for rural America. Nineteen percent of the rural population is 65 years or older, compared with 15% in urban areas. Whereas the average share of the population that is age 65+ is only 15.2% among large metropolitan counties, the average share of the population that is age 65+ is 21.7% in the smallest nonmetropolitan counties (see Figure 1). Nearly two-thirds of the U.S.’s 643 small metropolitan counties are considered “older-age counties”— counties where more than 20% of the population is age 65 or older (see Figure 2). Only 7% of large metropolitan counties fall into this category.
In addition to its implications for mortality rates, the older age structure in rural areas has implications for informal caregiving. Older adults nationwide rely on informal caregivers (e.g., friends, family, neighbors) for support, but access to informal caregivers may be more difficult in rural areas given longer travel times. This may lead to greater isolation among older adults in rural areas and may mean that they do not get necessary healthcare services and other essential resources, like medications, groceries, and social interaction.
Higher Prevalence of Chronic Health Conditions
Early data from China [PDF] show that people with certain serious chronic medical conditions, such as heart disease, diabetes, chronic respiratory disease, lung cancer, and depression are at greater risk of death and other serious complications from COVID-19 because these conditions weaken the body’s health defense and immune system against viral infection. Rural Americans have higher rates of each of these chronic health conditions than their urban peers (see Figure 3). This means that although transmission rates may be lower in rural areas, the percentage of cases resulting in death and other serious complications could be higher in rural than in urban areas.
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