A new study led by UNC Charlotte public health researchers is highlighting the progression of COVID-19 in urban and rural counties and revealing geographic disparities in the prevalence of the virus and how smoking, race, obesity and age influence that divide.
Using crowdsourced data on COVID‐19 and demographics, smoking rates and chronic diseases from more than 3,100 U.S. counties, a team including UNC Charlotte biostatistician Rajib Paul; epidemiologist Ahmed Arif; Ph.D. candidates Oluwaseun Adeyemi and Subhanwita Ghosh; and Dan Han, a mathematics professor at the University of Louisville, tracked the progression of the novel coronavirus across the U.S. from April 3-21.
Published in the Journal of Rural Health, the study found the average number of cases in urban counties increased from 10.1 to 107.6 per 100,000 people. In rural counties, that number increased from 3.6 to 43.6 per 100,000. While infection numbers were lower in rural counties, the rate of increase and growing numbers in those areas is cause for concern.
“Rural health care systems lack substantially in ICU infrastructures, ventilators and beds as compared to urban health care systems,” Paul said. “Additionally, the rural population is mostly poor, older and has higher smoking, hypertension, obesity and diabetes rates. These factors worsen disease outcomes.”
Adding to that concern is higher mortality rates for those comorbid conditions in rural counties as compared with urban counties.
The study adds to a flurry of findings confirming the racially disparate effects of COVID-19. Prevalence rates were substantially elevated in counties with higher black populations and in rural counties with higher black populations, the association was magnified.
The researchers also found that rates of COVID-19 increased six times more among young to middle-aged adults in rural counties as compared to urban counties.
As COVID-19 continues to surge in some areas, the researchers say they hope identifying disease hotspots can help legislatures channel appropriate resources to areas and influence decision making in county-specific, phased re-openings and openings of schools in various socioeconomic neighborhoods. Moving forward, studies such as this can help in emergency preparedness and guide choices in the creation of rural health care infrastructure.