Rural-urban and within-rural differences in COVID-19 mortality rates. (Special Issue: Space, place, and COVID-19.)

ABSTRACT

Since late-2020, COVID-19 mortality rates have been higher in rural than in urban America, but there has also been substantial within-rural heterogeneity. Using CDC data, we compare COVID-19 mortality rates across the rural-urban continuum as well as within rural counties across different types of labor markets and by metropolitan adjacency. As of October 1, 2021, the cumulative COVID-19 mortality rate was 247.0 per 100,000 population in rural counties compared to 200.7 in urban counties. Higher COVID-19 mortality rates in rural counties are explained by lower average educational attainment and lower median household income. Within rural counties, mortality rates have been highest in farming-dependent counties and lowest in recreation-dependent counties. Those differences are similarly explained by differences in educational attainment and median household income. Our findings have implications for ongoing COVID-19 prevention and vaccination efforts as well as for informing preparation efforts for future infectious disease outbreaks.