Deaths From COVID-19 in Rural, Micropolitan, and Metropolitan Areas: A County-Level Comparison
Deaths From COVID-19 in Rural, Micropolitan, and Metropolitan Areas: A County-Level Comparison
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DOI：
10.1111/jrh.12533
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发表时间：
2020-11-06
影响因子：
4.9
通讯作者：
Chen, Hsueh-Fen
中科院分区：
文献类型：
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作者：
Karim, Saleema A.;Chen, Hsueh-Fen
目的美国经历了COVID-19病例和死亡人数的激增。尽管患病率和死亡率总体上升，但对于接触和感染COVID-19的后果存在分歧，特别是在农村地区。农村地区的固有特征增加了其感染COVID-19的脆弱性。本研究的目的是调查美国城市和农村地区COVID-19死亡率的差异。数据集包括确诊的COVID-19病例和死亡沿着县级人口统计数据。样本包括美国50个州和华盛顿特区的所有县。县被指定为大都市，小都市和农村。使用零膨胀负二项回归估计以感染COVID-19为条件的县级死亡人数。研究重点是2020年2月10日至2020年6月12日期间的COVID-19相关死亡率。结果在控制县级特征后，COVID-19死亡率为70. 3%（P < .001）农村县和53.4%（P < .001）的小城市县，都显着低于大城市县在研究期间。结论随着时间的推移，农村的地理位置和社会隔离可能无法为农村居民提供可持续的保护，使其免受这一流行病的影响。进展缓慢，使农村地区有更多的时间和机会学习受影响最严重的城市地区的经验。农村地区需要积极主动，制定预防策略和应对计划，以管理和控制COVID-19的传播。
Purpose The United States has experienced a surge of COVID-19 cases and deaths. Regardless of the overall increase in the prevalence and mortality, there are disagreements about the consequences of exposure and contracting COVID-19, specifically in rural areas. Rural areas have inherent characteristics that increase their vulnerability to contracting COVID-19. The objective of this study was to investigate the differences in death rates from COVID-19 between urban and rural areas in the United States.Methods This study used county-level data. The data set consisted of confirmed COVID-19 cases and deaths along with county-level demographics. The sample consisted of all counties in the 50 US states and DC. Counties were designated as metropolitan, micropolitan, and rural. A zero-inflated negative binomial regression was used to estimate county-level number of deaths conditional on contracting COVID-19. The study focused on COVID-19-related mortality from February 10, 2020, to June 12, 2020.Findings After controlling for county-level characteristics, the rate of COVID-19 deaths was 70.3% (P < .001) for rural counties and 53.4% (P < .001) for micropolitan counties, both significantly lower than metropolitan counties during the study time period.Conclusion Over time, rural geography and social isolation may not provide sustainable protection to rural residents from the pandemic. The slow progression provides rural areas additional time and opportunity to learn from the experiences in urban areas that were most affected. Rural areas need to be proactive and develop prevention strategies and response plans to manage and control the spread of COVID-19.