Department of Biostatistics & Data Science, University of Kansas Medical Center, 3901 Rainbow Boulevard, 5032A Robinson Hall, Kanas City, KS, 66160, USA.
Popul Health Metr. 2024 Aug 14;22(1):20. doi: 10.1186/s12963-024-00340-2.
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 widely thought that issues such as access to care, age structure of the population, and differences in behavior are likely drivers of the rural mortality penalty, few studies have attempted to tie delayed access to care in rural populations to healthcare outcomes quantitatively. Therefore, 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. Nevertheless, it is widely thought that rural populations often experience delayed access to care, due to transportation and other constraints. Therefore, we hypothesized 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.
COVID-19 大流行使人们更加关注美国农村地区的死亡率，这一现象描述了农村地区的死亡率高于城市地区的现象。尽管人们普遍认为，获得医疗服务的机会、人口年龄结构和行为差异等问题可能是农村死亡率的驱动因素，但很少有研究试图将农村人口获得医疗服务的延迟与医疗保健结果进行定量联系。因此，了解这些因素对于制定更有效的公共卫生政策至关重要。
我们对美国 COVID-19 患者进行了一项横断面分析，这些患者于 2020 年 3 月 1 日至 2023 年 2 月 26 日期间住院。我们的目的是更好地了解导致农村和城市人群医疗结果差异的因素，这些患者都有一定程度的住院机会。尽管人们普遍认为，农村人口由于交通和其他限制，往往会延迟获得医疗服务。因此，我们假设患者入院时病情恶化可能解释了农村和城市人群之间死亡率差异的部分原因。
我们的结果支持了我们的假设，表明在这一人群中，农村死亡率仍然存在，并且通过多种指标，农村患者入院时的状况更差，整体健康状况更差，年龄更大。
尽管大流行使农村死亡率问题突显出来，但重要的是要记住，这种现象在大流行之前就已经存在，并且在实施有效的干预措施之前，它将继续存在。这项研究表明，迫切需要解决导致农村患者在 COVID-19 大流行期间比城市患者入院时病情更差的根本因素，这可能也会影响其他医疗保健结果。
