Document Type
Article
Publication Date
7-2-2024
Publication Title
Journal of Rural Health
Abstract
Purpose: To investigate the enduring disparities in adverse COVID-19 events between urban and rural communities in the United States, focusing on the effects of SARS-CoV-2 vaccination and therapeutic advances on patient outcomes. Methods: Using National COVID Cohort Collaborative (N3C) data from 2021 to 2023, this retrospective cohort study examined COVID-19 hospitalization, inpatient death, and other adverse events. Populations were categorized into urban, urban-adjacent rural (UAR), and nonurban-adjacent rural (NAR). Adjustments included demographics, variant-dominant waves, comorbidities, region, and SARS-CoV-2 treatment and vaccination. Statistical methods included Kaplan-Meier survival estimates, multivariable logistic, and Cox regression. Findings: The study included 3,018,646 patients, with rural residents constituting 506,204. These rural dwellers were older, had more comorbidities, and were less vaccinated than their urban counterparts. Adjusted analyses revealed higher hospitalization odds in UAR and NAR (aOR 1.07 [1.05–1.08] and 1.06 [1.03–1.08]), greater inpatient death hazard (aHR 1.30 [1.26–1.35] UAR and 1.37 [1.30–1.45] NAR), and greater risk of other adverse events compared to urban dwellers. Delta increased, while Omicron decreased, inpatient adverse events relative to pre-Delta, with rural disparities persisting throughout. Treatment effectiveness and vaccination were similarly protective across all cohorts, but dexamethasone post-ventilation was effective only in urban areas. Nirmatrelvir/ritonavir and molnupiravir better protected rural residents against hospitalization. Conclusions: Despite advancements in treatment and vaccinations, disparities in adverse COVID-19 outcomes persist between urban and rural communities. The effectiveness of some therapeutic agents appears to vary based on rurality, suggesting a nuanced relationship between treatment and geographic location while highlighting the need for targeted rural health care strategies.
PubMed ID
38953158
Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.
Recommended Citation
Anzalone, A. Jerrod; Beasley, William H.; Murray, Kimberly; Hillegass, William B.; Schissel, Makayla; Vest, Michael T.; Chapman, Scott A.; Horswell, Ronald; Miele, Lucio; Porterfield, J. Zachary; Bunnell, H. Timothy; Price, Bradley S.; Patrick, Sharon; Rosen, Clifford J.; Santangelo, Susan L.; McClay, James C.; and Hodder, Sally L., "Associations between COVID-19 therapies and outcomes in rural and urban America: A multisite, temporal analysis from the Alpha to Omicron SARS-CoV-2 variants" (2024). School of Medicine Faculty Publications. 2862.
https://digitalscholar.lsuhsc.edu/som_facpubs/2862
10.1111/jrh.12857