Epidemic Intelligence Service, Centers for Disease Control and Prevention, Division of Scientific Education and Professional Development, Atlanta, Georgia (Dr Grome); Division of Communicable and Environmental Diseases and Emergency Preparedness, Tennessee Department of Health, Nashville, Tennessee (Drs Grome, Fill, Jones, and Dunn and Mr Katz); and Departments of Biostatistics (Dr Raman) and Health Policy (Dr Schaffner), Vanderbilt University School of Medicine, Nashville, Tennessee.
J Public Health Manag Pract. 2022;28(5):478-485. doi: 10.1097/PHH.0000000000001507. Epub 2022 Apr 5.
It is well established that rural communities face geographic and socioeconomic challenges linked to higher rates of health disparities across the United States, though the coronavirus disease 2019 (COVID-19) impact on rural communities is less certain.
To understand the COVID-19 pandemic's impact on rural communities in Tennessee, investigate differences in rural-urban mortality rates after controlling for confounding variables, and inform state pandemic response policy.
A cross-sectional analysis of cumulative COVID-19 morality rates.
SETTING/PARTICIPANTS: Tennessee county-level COVID-19 mortality data from March 1, 2020, to January 31, 2021, were matched with county-level sociodemographic and health data from public datasets: Agency for Healthcare Research and Quality Social Determinants of Health, PLACES: Local Data for Better Health County Data, and the US Census Bureau. County status was defined using the 2013 National Center for Health Statistics Urban-Rural Classification.
A negative binomial regression model estimated adjusted incidence rate ratio and 95% confidence intervals (CI) for rural compared with urban mortality. Unadjusted rate ratios and rate differences for COVID-19 mortality in rural versus urban counties were compared with those for influenza and pneumonia and all-cause mortality over the past 5 years.
During the study period, 9650 COVID-19 deaths occurred across 42 urban and 53 rural counties. Controlling for county-level sociodemographic characteristics, health care access, and comorbidities, incidence rate ratio was 1.13 (95% CI, 1.00-1.28, P < .05) for rural as compared with urban deaths. Unadjusted COVID-19 mortality risk difference between rural and urban counties was greater (61.85, 95% CI, 54.31-69.31) than 5-year influenza and pneumonia rural-urban risk difference (12.57, 95% CI, 11.16-13.00) during 2015-2019.
COVID-19 mortality rates were greater for populations living in Tennessee's rural as compared with urban counties during the study period. This differential impact must be considered in public health decision making to mitigate COVID-19.
众所周知，美国农村社区面临着与较高健康差异率相关的地理和社会经济挑战，但 2019 年冠状病毒病（COVID-19）对农村社区的影响尚不确定。
了解 COVID-19 大流行对田纳西州农村社区的影响，在控制混杂变量后调查农村与城市死亡率的差异，并为州大流行应对政策提供信息。
COVID-19 死亡率的横断面分析。
设置/参与者：2020 年 3 月 1 日至 2021 年 1 月 31 日，田纳西州县 COVID-19 死亡率数据与公共数据集的县社会人口统计学和健康数据相匹配：医疗保健研究和质量社会决定因素，地点：地方数据改善健康县数据和美国人口普查局。县地位使用 2013 年国家卫生统计中心城市-农村分类法定义。
使用负二项回归模型估计农村与城市死亡率相比的调整发病率比和 95%置信区间（CI）。比较 COVID-19 死亡率在农村与城市县的未调整率比和率差异与过去 5 年流感和肺炎以及全因死亡率的差异。
在研究期间，42 个城市和 53 个农村县发生了 9650 例 COVID-19 死亡。在控制县社会人口统计学特征、医疗保健可及性和合并症后，农村与城市死亡的发病率比为 1.13（95%CI，1.00-1.28，P <.05）。农村与城市县之间未调整的 COVID-19 死亡率风险差异大于 2015-2019 年 5 年流感和肺炎的农村-城市风险差异（61.85，95%CI，54.31-69.31）。
在研究期间，田纳西州农村社区的 COVID-19 死亡率高于城市社区。在公共卫生决策中必须考虑这种差异影响，以减轻 COVID-19 的影响。
