Abstract
Studies examining the role of geographic factors in coronavirus disease-2019 (COVID-19) epidemiology among rural populations are lacking. Our study is a population-based longitudinal study based on rural residents in four southeast Minnesota counties from March through October 2020. We used a kernel density estimation approach to identify hotspots for COVID-19 cases. Temporal trends of cases and testing were examined by generating a series of hotspot maps during the study period. Household/individual-level socioeconomic status (SES) was measured using the HOUSES index and examined for association between identified hotspots and SES. During the study period, 24,243 of 90,975 residents (26.6%) were tested for COVID-19 at least once; 1498 (6.2%) of these tested positive. Compared to other rural residents, hotspot residents were overall younger (median age: 40.5 vs 43.2), more likely to be minorities (10.7% vs 9.7%), and of higher SES (lowest HOUSES [SES] quadrant: 14.6% vs 18.7%). Hotspots accounted for 30.1% of cases (14.5% of population) for rural cities and 60.8% of cases (27.1% of population) for townships. Lower SES and minority households were primarily affected early in the pandemic and higher SES and non-minority households affected later. In rural areas of these four counties in Minnesota, geographic factors (hotspots) play a significant role in the overall burden of COVID-19 with associated racial/ethnic and SES disparities, of which pattern differed by the timing of the pandemic (earlier in pandemic vs later). The study results could more precisely guide community outreach efforts (e.g., public health education, testing/tracing, and vaccine roll out) to those residing in hotspots.
Highlights
While rural areas initially experienced lower testing and cases,6,7 since August 2020, the trends have reversed with COVID-19 cases per capita in small/medium metro and non-metro areas exceeding large metro central and fringe areas after mid-August 2020.8,9 Death rates in non-metro areas exceeded death rates in metro areas from late August to mid December 2020.10 Compared with urban residents, people living in rural areas report less willingness to be vaccinated for COVID-1911,12, and, as our community-based survey indicated, less engagement in COVID-19 preventive behaviors, e.g., masking
From March through October, the total number of COVID-19 cases was 142,311 in Minnesota and 4,880 in the four-county area that is the focus of this study14, with rural areas accounting for an estimated 41% of area cases based on Rochester Epidemiology Project data (REP; an NIHfunded data linkage system for study populations)
Characteristics of study subjects: Of 90,975 rural residents included in the analysis, 51.7% were female, 92.9% were White (90.1% non-Hispanic Whites (NHW)), 1.0% African American, 0.8% Asian, and 0.4% American Indian, 3.6% other race or two or more races (Other/Mixed); 4.7% reported Hispanic ethnicity
Summary
The rapid spread of coronavirus disease-2019 (COVID-19) has created a worldwide pandemic with high morbidity and mortality rates. Nationally, there is a disproportionate impact on rural populations in terms of deaths and hospitalizations. While rural areas initially experienced lower testing and cases, since August 2020, the trends have reversed with COVID-19 cases per capita in small/medium metro and non-metro areas exceeding large metro central and fringe areas after mid-August 2020.8,9 Death rates in non-metro areas exceeded death rates in metro areas from late August to mid December 2020.10 Compared with urban residents, people living in rural areas report less willingness to be vaccinated for COVID-1911,12, and, as our community-based survey indicated, less engagement in COVID-19 preventive behaviors, e.g., masking.13Minnesota’s Governor issued a Shelter-in-Place order from March 27, 2020, to May 13, 2020. From March through October, the total number of COVID-19 cases was 142,311 in Minnesota and 4,880 in the four-county area that is the focus of this study, with rural areas accounting for an estimated 41% of area cases based on Rochester Epidemiology Project data (REP; an NIHfunded data linkage system for study populations). Studies examining the role of geographic factors in COVID-19 epidemiology among rural populations are lacking. Methods: Our study is a population-based longitudinal study based on rural residents in four southeast Minnesota counties from March through October 2020. Conclusion: In rural areas of these four counties in Minnesota, geographic factors (hotspots) play a significant role in the overall burden of COVID-19 with associated racial/ethnic and SES disparities, of which pattern differed by the timing of the pandemic (earlier in pandemic vs later).
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