Higher hospitalization and mortality rates among SARS-CoV-2-infected persons in rural America

Authors

Alfred Jerrod Anzalone, University of Nebraska Medical Center, Omaha, Nebraska, USA.
Ronald Horswell, Pennington Biomedical Research Centre, Baton Rouge, Louisiana, USA.
Brian M. Hendricks, West Virginia University, Morgantown, West Virginia, USA.
San Chu, Pennington Biomedical Research Centre, Baton Rouge, Louisiana, USA.
William B. Hillegass, University of Mississippi Medical Center, Jackson, Mississippi, USA.
William H. Beasley, University of Oklahoma, Norman, Oklahoma, USA.
Jeremy R. Harper, Owl Health Works LLC, Indianapolis, Indiana, USA.
Wesley Kimble, West Virginia University, Morgantown, West Virginia, USA.
Clifford J. Rosen, Maine Medical Center
Lucio Miele, LA CaTS Center, Baton Rouge, Louisiana, USA.
James C. McClay, University of Nebraska Medical Center, Omaha, Nebraska, USA.
Susan L. Santangelo, Maine Medical Center
Sally L. Hodder, West Virginia University, Morgantown, West Virginia, USA.

Document Type

Article

Publication Date

1-2023

Journal Title

The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association

MeSH Headings

Humans; United States (epidemiology); SARS-CoV-2; COVID-19 (epidemiology, therapy); Rural Population; Retrospective Studies; Hospitalization

Abstract

PURPOSE: Rural communities are among the most underserved and resource-scarce populations in the United States. However, there are limited data on COVID-19 outcomes in rural America. This study aims to compare hospitalization rates and inpatient mortality among SARS-CoV-2-infected persons stratified by residential rurality. METHODS: This retrospective cohort study from the National COVID Cohort Collaborative (N3C) assesses 1,033,229 patients from 44 US hospital systems diagnosed with SARS-CoV-2 infection between January 2020 and June 2021. Primary outcomes were hospitalization and all-cause inpatient mortality. Secondary outcomes were utilization of supplemental oxygen, invasive mechanical ventilation, vasopressor support, extracorporeal membrane oxygenation, and incidence of major adverse cardiovascular events or hospital readmission. The analytic approach estimates 90-day survival in hospitalized patients and associations between rurality, hospitalization, and inpatient adverse events while controlling for major risk factors using Kaplan-Meier survival estimates and mixed-effects logistic regression. FINDINGS: Of 1,033,229 diagnosed COVID-19 patients included, 186,882 required hospitalization. After adjusting for demographic differences and comorbidities, urban-adjacent and nonurban-adjacent rural dwellers with COVID-19 were more likely to be hospitalized (adjusted odds ratio [aOR] 1.18, 95% confidence interval [CI], 1.16-1.21 and aOR 1.29, CI 1.24-1.1.34) and to die or be transferred to hospice (aOR 1.36, CI 1.29-1.43 and 1.37, CI 1.26-1.50), respectively. All secondary outcomes were more likely among rural patients. CONCLUSIONS: Hospitalization, inpatient mortality, and other adverse outcomes are higher among rural persons with COVID-19, even after adjusting for demographic differences and comorbidities. Further research is needed to understand the factors that drive health disparities in rural populations.

First Page

39

Last Page

54

Recommended Citation

Anzalone AJ, Horswell R, Hendricks BM, et al. Higher hospitalization and mortality rates among SARS-CoV-2-infected persons in rural America. J Rural Health. 2023;39(1):39-54. doi:10.1111/jrh.12689