Vaccinations Reduced Racial and Ethnic Disparities in COVID-19 Outcomes in Rural Counties

Abstract

<h3>Context:</h3> Before availability of COVID-19 vaccinations, rural counties with majority racial and ethnic minority populations were disproportionately impacted by COVID-19 compared to majority Non-Hispanic White (NHW) counties. <h3>Objective:</h3> Describe disparities in COVID-19 outcomes across majority NHW and minority NHW rural counties before and after the widespread availability of COVID-19 vaccinations. <h3>Study Design:</h3> Rural counties were categorized as &lt;10% People of Color (POC), 10-50% POC, and &lt;50% POC. We described each group across the below measures before and after the widespread availability of COVID-19 vaccination. We created a choropleth map of the categories. <h3>Datasets:</h3> We obtained COVID-19 cases and deaths from USA Facts. Estimates of 2019 county-level sociodemographic measures came from the US Census. Number of hospital beds and primary care physicians (PCP) were obtained from the Area Health Resource File. We obtained county chronic condition prevalence, social vulnerability index (SVI) and COVID vaccination rates from the Centers for Disease Control. <h3>Study Population:</h3> US counties not located in a Metropolitan Statistical Area. <h3>Intervention:</h3> Widespread availability of COVID-19 vaccinations. (pre-vaccination period: March 11, 2020, to April 18, 2021; post-vaccination period: April 19, 2021, to November 28, 2021). <h3>Measures:</h3> Cumulative case/death rates, average daily case/death rates, sociodemographic characteristics, SVI, vaccination rate, chronic condition prevalence, PCP supply, and hospital beds. <h3>Results:</h3> Of 1982 rural counties, 238 were majority POC rural counties, 1074 had 10-50% POC, and 670 had &lt;10% POC. Counties with higher proportions of POC had higher rates of poverty, unemployment, uninsured, and SVI and worse access to primary care. As proportion POC in the county increased, vaccination rates increased, from an average of 44.7% of the county with at least 1 dose of vaccine among counties with &lt;10% POC to an average of 55.1% in majority POC counties. Prior to widespread vaccine availability there were disparities in the average daily and cumulative case and death rates across the three groups, which were reduced or equalized after widespread vaccine availability. <h3>Conclusions:</h3> Majority POC rural counties had higher rates of vaccination uptake than majority NHW rural counties. Disparities in COVID-19 outcomes between majority POC rural counties and majority NHW rural counties improved after the widespread availability of vaccination.