Disparities in COVID-19 Vaccination Coverage Between Urban and Rural Counties - United States, December 14, 2020-April 10, 2021

Abstract

Approximately 60 million persons in the United States live in rural counties, representing almost one fifth (19.3%) of the population.* In September 2020, COVID-19 incidence (cases per 100,000 population) in rural counties surpassed that in urban counties (1). Rural communities often have a higher proportion of residents who lack health insurance, live with comorbidities or disabilities, are aged ≥65 years, and have limited access to health care facilities with intensive care capabilities, which places these residents at increased risk for COVID-19-associated morbidity and mortality (2,3). To better understand COVID-19 vaccination disparities across the urban-rural continuum, CDC analyzed county-level vaccine administration data among adults aged ≥18 years who received their first dose of either the Pfizer-BioNTech or Moderna COVID-19 vaccine, or a single dose of the Janssen COVID-19 vaccine (Johnson & Johnson) during December 14, 2020-April 10, 2021 in 50 U.S. jurisdictions (49 states and the District of Columbia [DC]). Adult COVID-19 vaccination coverage was lower in rural counties (38.9%) than in urban counties (45.7%) overall and among adults aged 18-64 years (29.1% rural, 37.7% urban), those aged ≥65 years (67.6% rural, 76.1% urban), women (41.7% rural, 48.4% urban), and men (35.3% rural, 41.9% urban). Vaccination coverage varied among jurisdictions: 36 jurisdictions had higher coverage in urban counties, five had higher coverage in rural counties, and five had similar coverage (i.e., within 1%) in urban and rural counties; in four jurisdictions with no rural counties, the urban-rural comparison could not be assessed. A larger proportion of persons in the most rural counties (14.6%) traveled for vaccination to nonadjacent counties (i.e., farther from their county of residence) compared with persons in the most urban counties (10.3%). As availability of COVID-19 vaccines expands, public health practitioners should continue collaborating with health care providers, pharmacies, employers, faith leaders, and other community partners to identify and address barriers to COVID-19 vaccination in rural areas (2).

Figure 1

Percentage of vaccinated persons who traveled outside their county of residence for their first dose of COVID-19 vaccine, by jurisdiction and urban-rural classification — United States, December 14, 2020–April 10, 2021 * Excludes doses with state of residence reported as Hawaii, a territory, an island, or a county of residence in California with population <20,000. Completeness of county data varied by jurisdiction. Three states (Georgia, South Dakota, and West Virginia) had <80% completeness for county of residence data. Four jurisdictions (Delaware, New Jersey, Rhode Island, and District of Columbia) did not have rural counties. ^† First dose of COVID-19 vaccine is defined either as the first of 2 doses for the Pfizer-BioNTech or Moderna vaccines, or a single dose for the Janssen (Johnson & Johnson) vaccine. ^§ First doses of COVID-19 vaccine were matched by county of residence to one of six urban-rural categories according to the 2013 National Center for Health Statistics urban-rural classification scheme (https://www.cdc.gov/nchs/data/series/sr_02/sr02_166.pdf). To further classify counties into two categories (urban versus rural), four of these six categories were combined into urban areas (large central metropolitan, large fringe metropolitan, medium metropolitan, and small metropolitan) and two were combined into rural areas (micropolitan and noncore).

Figure 2

Location of receipt of first COVID-19 vaccine dose among vaccinated persons, by urban-rural classification of county of residence^,, — United States, December 14, 2020–April 10, 2021 * First dose of COVID-19 vaccine is defined either as the first of 2 doses for the Pfizer-BioNTech or Moderna vaccines, or a single dose for the Janssen (Johnson & Johnson) vaccine. ^† Excludes doses with state of residence reported as Hawaii, a territory, an island, or a county of residence in California with population <20,000. Completeness of county data varied by jurisdiction. Three states (Georgia, South Dakota, and West Virginia) had <80% completeness for county of residence data. ^§ First doses of COVID-19 vaccine were matched by county of residence to one of six urban-rural categories according to the 2013 National Center for Health Statistics urban-rural classification scheme (https://www.cdc.gov/nchs/data/series/sr_02/sr02_166.pdf). To further classify counties into two categories (urban versus rural), four of these six categories were combined into urban areas (large central metropolitan, large fringe metropolitan, medium metropolitan, and small metropolitan) and two were combined into rural areas (micropolitan and noncore). ^¶ Large fringe metropolitan refers to suburban areas.