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. 2021 Jul:59:16-20.
doi: 10.1016/j.annepidem.2021.04.007. Epub 2021 Apr 22.

Dynamics of the COVID-19 epidemic in urban and rural areas in the United States

Diego F Cuadros  1 , Adam J Branscum  2 , Zindoga Mukandavire  3 , F DeWolfe Miller  4 , Neil MacKinnon  5
Affiliations

Dynamics of the COVID-19 epidemic in urban and rural areas in the United States

Diego F Cuadros et al. Ann Epidemiol. 2021 Jul.

Abstract

Purpose: There is a growing concern about the COVID-19 epidemic intensifying in rural areas in the United States (U.S.). In this study, we described the dynamics of COVID-19 cases and deaths in rural and urban counties in the U.S.

Methods: Using data from April 1 to November 12, 2020, from Johns Hopkins University, we estimated COVID-19 incidence and mortality rates and conducted comparisons between urban and rural areas in three time periods at the national level, and in states with higher and lower COVID-19 incidence rates.

Results: Results at the national level showed greater COVID-19 incidence rates in urban compared to rural counties in the Northeast and Mid-Atlantic regions of the U.S. at the beginning of the epidemic. However, the intensity of the epidemic has shifted to a rapid surge in rural areas. In particular, high incidence states located in the Mid-west of the country had more than 3,400 COVID-19 cases per 100,000 people compared to 1,284 cases per 100,000 people in urban counties nationwide during the third period (August 30 to November 12).

Conclusions: Overall, the current epicenter of the epidemic is located in states with higher infection rates and mortality in rural areas. Infection prevention and control efforts including healthcare capacity should be scaled up in these vulnerable rural areas.

Keywords: Covid-19; Disease mapping; Spatial epidemiology; United states: rural areas.

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Figures

Fig1
Fig. 1
Spatial distribution of COVID-19 incidence rates per 100,000 people (maps on the top), and spatial distribution of COVID-19 related mortality rates per 100,000 people (maps on the bottom) during the three time periods of the study. High incidence states are delineated with a thick dark line. Maps were created using ArcGIS by ESRI version 10.3 (http://www.esri.com).
See this image and copyright information in PMC

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