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. 2023 May 26;72(21):574-578.
doi: 10.15585/mmwr.mm7221a2.

Urban and Rural Mpox Incidence Among Persons Aged 15-64 Years - United States, May 10-December 31, 2022

Affiliations

Urban and Rural Mpox Incidence Among Persons Aged 15-64 Years - United States, May 10-December 31, 2022

Carla E Zelaya et al. MMWR Morb Mortal Wkly Rep. .

Abstract

During May 10-December 31, 2022, a total of 29,980 confirmed and probable U.S. monkeypox (mpox) cases were reported to CDC, predominantly in cisgender adult men reporting recent same-gender sexual partners (1). Urban-rural differences in health (2) and diagnosis of HIV (3,4) and other sexually transmitted infections (5) are well documented nationally. This report describes urban-rural differences in mpox incidence (cases per 100,000 population) among persons aged 15-64 years, by gender and race and ethnicity. Urbanicity was assessed using the 2013 National Center for Health Statistics (NCHS) Urban-Rural Classification Scheme for Counties (2). Substantial differences in incidence by urbanicity, gender, and race and ethnicity were observed; most (71.0%) cases occurred in persons residing in large central urban areas. Among the cases in large central urban areas, most (95.7%) were in cisgender men. The overall incidence of mpox in the United States was 13.5 per 100,000 persons aged 15-64 years and peaked in August in both urban and rural areas. Among cisgender men, incidence in rural areas was approximately 4% that in large central urban areas (risk ratio [RR] = 0.04). Among cisgender women, incidence in rural areas was approximately 11% that in large central urban areas (RR = 0.11). In both urban and rural areas, incidence among non-Hispanic Black or African American (Black) and Hispanic or Latino (Hispanic) persons was consistently higher than that among non-Hispanic White (White) persons; RRs between Black and White persons were highest in rural areas. Support and maintenance of mpox surveillance and prevention efforts including vaccinations should focus on urban areas with the highest incidence of mpox during the 2022 outbreak; however, surveillance and prevention efforts should include all genders, persons of color, and persons residing in both urban and rural areas who are at increased risk for mpox.

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Conflict of interest statement

All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. Siobhán O’Connor reports patent applications for kits and methods for determining physiologic levels, ranges of hemoglobin, and disease state, unrelated to the current work. No other potential conflicts of interest were disclosed.

Figures

FIGURE
FIGURE
Mpox incidence among persons aged 15–64 years, by gender (A), race and ethnicity (B), and urban-rural classification of county of residence — United States, May 10–December 31, 2022 * Cases per 100,000 population. Risk was calculated by using summed case counts and population size (persons aged 15–64 years) by gender and race and ethnicity and each level of urban-rural classification, multiplied by 100,000. Methods for collecting gender information are not standardized across all jurisdictions. When self-reported gender was missing, current sex or sex assigned at birth was used, and gender identity was presumed to be cisgender. Among the 29,311 cases reported in 2022, 238 cases were missing data on gender (i.e., gender, sex, and sex assigned at birth). Among cases reported in cisgender men (27,726), 129 were missing information on county of residence, and risk for cisgender men was calculated from a total of 27,597 mpox cases among cisgender men. Among cases reported in cisgender women (822), two were missing information on county of residence, and incidence among cisgender women was calculated from a total of 820 mpox cases. § All persons who reported Hispanic or Latino (Hispanic) ethnicity, regardless of race, were categorized as Hispanic. Persons who did not report ethnicity as Hispanic (including missing ethnicity) were categorized as non-Hispanic and reported race in the following categories: American Indian or Alaska Native, Asian, Black or African American (Black), Native Hawaiian or other Pacific Islander, White, and multiple races (more than one race category selected) or other race. This figure includes Black, Hispanic, and White racial and ethnic groups; incidence in all other groups was unreliable because of small sample sizes and were not included (https://stacks.cdc.gov/view/cdc/128433). Persons with missing data on ethnicity and race were categorized as missing or unknown. Among the 29,311 cases reported in 2022, 1,727 cases were missing data on race and ethnicity. Incidences among Black, Hispanic, and White persons were calculated using 9,151, 8,500, and 8,500 cases, respectively, because of the number of cases missing information on county of residence (20 of 9,171 [Black], 26 of 8,526 [Hispanic], and 29 of 8,079 [White]). Urban-rural classification of county of residence is based on the 2013 National Center for Health Statistics Urban-Rural Classification Scheme for Counties. The two nonmetro categories were combined into one rural (i.e., nonmetropolitan) category.

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