Rural Americans are dying of COVID-19 at higher rates than their urban counterparts—a divide that health experts say is likely to widen as access to medical care shrinks for a population that tends to be older, sicker, heavier, poorer, and less vaccinated.

While the initial surge of COVID-19 deaths skipped over much of rural America, where roughly 15% of Americans live, nonmetropolitan mortality rates quickly started to outpace those of metropolitan areas as the virus spread nationwide before vaccinations became available, according to a report from the RUPRI Center for Rural Health Policy Analysis. Keith Mueller, director of the center, and Fred Ullrich, research analyst with the center, co-author the regularly updated report

The earliest surge in the pandemic (spring 2020) largely took place in metropolitan areas (both incidence and mortality), according to the report. The second surge (summer 2020) saw increases in incidence and mortality in both metropolitan and nonmetropolitan areas. However, it was at that time that nonmetropolitan incidence and mortality rates surpassed those in metropolitan areas. Both rates were higher in nonmetropolitan areas during the third surge until its peak in January 2021.

Following that peak, metropolitan and nonmetropolitan rates declined in similar fashion with incidence rates (for both geographies) leveling off in the spring and then declining until July 2021. At that time incidence rates started rising sharply with mortality rates following suit in August. Although that surge appears to have peaked in late September, incidence and mortality rates remain much higher in nonmetropolitan counties than those in metropolitan counties, according to the report published Dec. 1, 2021.

Hospital closures and shortages of health care providers may contribute to the high mortality rates from COVID-19 in rural areas. “We know that around the country since 2010, over 130 rural hospitals have closed,” Mueller told the Daily Iowan. “In many places, that was the cornerstone of care in the community.”

The latest report can be found at https://rupri.public-health.uiowa.edu/.

Media Coverage

Keith Mueller and Fred Ullrich on COVID-19 related deaths in rural areas – Washington Journal/C-SPAN

Covid is killing rural Americans at twice the rate of people in urban areas – NBC News

COVID-19 death rate in rural America now double that of urban communities – CBS News

700,000 Americans now dead from COVID-19—but deaths reveal deep disparities – National Geographic

Rural Westerners more likely to die from COVID-19 than city dwellers – KUNC