Thompson Jeffrey A, Mudaranthakam Dinesh Pal, Chollet-Hinton Lynn
University of Kansas Medical Center.
Res Sq. 2023 Nov 10:rs.3.rs-3467683. doi: 10.21203/rs.3.rs-3467683/v1.
The COVID-19 pandemic brought greater focus to the rural mortality penalty in the U.S., which describes the greater mortality rate in rural compared to urban areas. Although it is understood that issues such as access to care, age structure of the population, and differences in behavior are likely drivers of the rural mortality penalty, it is critical to try and understand these factors to enable more effective public health policy.
We performed a cross-sectional analysis of a population of patients with COVID-19 who were admitted to hospitals in the United States between 3/1/2020 and 2/26/2023 to better understand factors leading to outcome disparities amongst groups that all had some level of access to hospital care, hypothesizing that deteriorated patient condition at admission likely explained some of the observed difference in mortality between rural and urban populations.
Our results supported our hypothesis, showing that the rural mortality penalty persists in this population and that by multiple measures, rural patients were likely to be admitted in worse condition, had worse overall health, and were older.
Although the pandemic threw the rural mortality penalty into sharp relief, it is important to remember that it existed prior to the pandemic and will continue to exist until effective interventions are implemented. This study demonstrates the critical need to address the underlying factors that resulted in rural-dwelling patients being admitted to the hospital in worse condition than their urban-dwelling counterparts during the COVID-19 pandemic, which likely affected other healthcare outcomes as well.
新冠疫情使人们更加关注美国农村地区的死亡率劣势，即农村地区的死亡率高于城市地区。尽管人们知道诸如医疗服务可及性、人口年龄结构和行为差异等问题可能是农村死亡率劣势的驱动因素，但了解这些因素对于制定更有效的公共卫生政策至关重要。
我们对2020年3月1日至2023年2月26日期间在美国医院住院的新冠患者群体进行了横断面分析，以更好地了解在所有都有一定程度医院医疗服务可及性的群体中导致结果差异的因素，假设入院时患者病情恶化可能解释了农村和城市人口之间观察到的死亡率差异的一部分。
我们的结果支持了我们的假设，表明在这一群体中农村死亡率劣势依然存在，并且通过多项指标显示，农村患者入院时病情可能更糟，整体健康状况更差，且年龄更大。
尽管疫情使农村死亡率劣势凸显出来，但重要的是要记住，它在疫情之前就已存在，并且在实施有效干预措施之前将继续存在。这项研究表明，迫切需要解决导致新冠疫情期间农村居民患者入院时病情比城市居民患者更糟的潜在因素，这可能也影响了其他医疗结果。
