Half of Rural Residents at High Risk of Serious Illness Due to COVID-19, Creating Stress on Rural Hospitals

Abstract

Purpose: During the COVID-19 epidemic, it is critical to understand how the need for hospital care in rural areas aligns with the capacity across states.

Methods: We analyzed data from the 2018 Behavioral Risk Factor Surveillance System to estimate the number of adults who have an elevated risk of serious illness if they are infected with coronavirus in metropolitan, micropolitan, and rural areas for each state. Study data included 430,949 survey responses representing over 255.2 million noninstitutionalized US adults. For data on hospital beds, aggregate survey data were linked to data from the 2017 Area Health Resource Files by state and metropolitan status.

Findings: About 50% of rural residents are at high risk for hospitalization and serious illness if they are infected with COVID-19, compared to 46.9% and 40.0% in micropolitan and metropolitan areas, respectively. In 19 states, more than 50% of rural populations are at high risk for serious illness if infected. Rural residents will generate an estimated 10% more hospitalizations for COVID-19 per capita than urban residents given equal infection rates.

Conclusion: More than half of rural residents are at increased risk of hospitalization and death if infected with COVID-19. Experts expect COVID-19 burden to outpace hospital capacity across the country, and rural areas are no exception. Policy makers need to consider supply chain modifications, regulatory changes, and financial assistance policies to assist rural communities in caring for people affected by COVID-19.

Keywords: COVID-19; access to care; health care utilization; rural health; serious illness.

Figure 1

Mean Proportion of Residents at High Risk Nationally Due to COVID‐19 by Metropolitan Status. Source: Authors’ analysis of 2018 Behavioral Risk Factor Surveillance System data.

Figure 2

Proportion of States’ Residents at Risk of Serious Illness Due to COVID‐19 in Metropolitan, Micropolitan, and Rural Areas. Source: Authors’ analysis of 2018 Behavioral Risk Factor Surveillance System data.

Figure 3

Percent of Rural Residents at High Risk of Serious Illness Due to COVID‐19. Source: Authors’ analysis of 2018 Behavioral Risk Factor Surveillance System data.

Figure 4

Number of Hospital Beds Compared to Estimated COVID‐19 Hospitalizations for State Metropolitan, Micropolitan, and Rural Populations. Source: Authors’ analysis of 2018 Behavioral Risk Factor Surveillance System and 2017 Area Health Resource File data. Truncated to show observations with state high‐risk population less than a half million people. Assumes 30% of high‐ and low‐risk populations are infected with COVID‐19 and assumes a 10% hospitalization rate in low‐risk populations and 30% hospitalization rate in high‐risk populations.