Adults In Rural Communities Research Articles

Protective and high-risk social activities associated with homebound status among older adults in rural Japan

Becoming homebound can be devastating for older adults in rural communities. This study aimed to identify protective or high-risk social activities associated with homebound status among the rural young old (ages 65–74) and the oldest old (ages ≥ 75). We used data from a survey of older adults in a rural community of Japan in 2014. Questions covered sociodemographic characteristics, homebound status (i.e., going out less than once a week), physical and psychological status, and social activities. Using survey data, we conducted logistic regression analysis to identify protective and high-risk social activities associated with homebound status. Of the 1,564 participants, 51.0 % were the oldest old, and the mean age was 75.2 (±7.0) years. The prevalence of homebound status was 10.5 % total: 5.2 % among the young old and 15.7 % among the oldest old and highest among the female oldest old (19.4 %). The main protective social activity for the young and the oldest old was visiting friends’ houses (adjusted odds ratio [AOR] 5.38, 95 % confidence interval [CI] 1.64–17.64 and AOR 3.49, 95 % CI 1.07–11.42, respectively). For the young old, specific high-risk social activities were advising family and friends (AOR 0.07, 95 % CI 0.01–0.62) and activities to support older adults (AOR 0.17, 95 % CI 0.03–0.84). For the oldest old, a protective social activity was participating in long-term care prevention programs (AOR 28.94, 95 % CI 1.90–441.63). To prevent rural older adults from becoming homebound, support should be provided according to protective and high-risk social activities for age groups, with particular attention to safe socialization amid the threat of COVID-19.

Epidemiological characteristics of different patterns of obesity among adults in rural communities of south-east Nigeria: a population-based cross-sectional study

BackgroundObesity is a complex disease characterised by excess fat accumulation and health risks. There is paucity of data on epidemiology of obesity patterns among adults in rural Nigeria. This study aimed to provide current data on the prevalence and predictors of three patterns of obesity (abdominal obesity alone, general obesity alone and a combination of both) among adults in three rural communities of Enugu State, South-east Nigeria to enhance specific obesity prevention and control programmes/interventions.MethodsThis population-based cross-sectional study involved 500 adults selected through a six-stage random sampling technique. Questionnaire was used to obtain data on socio-economic, dietary and lifestyle characteristics of the respondents. Weight, height and waist circumference were measured by standard procedures. Body mass index was used to assess general obesity while abdominal obesity was assessed through waist circumference. Each respondent was classified under only one of the three patterns: general obesity alone, abdominal obesity alone and combined obesity. Binary and multivariate logistic regression analyses were used to assess the predictors. Significance was set P<0.05.ResultsPrevalence of abdominal obesity alone was 6.0%. General obesity alone was found among 31.4% and 45.6% were affected by combined obesity. Being a female (AOR:0.35, 95% C.I.: 0.14, 0.88) and not skipping meals (AOR:0.24, 95% C.I.: 0.10, 0.55) were associated with less likelihood of abdominal obesity but ≥3 times daily meal intake increased the risk by 2.52 (AOR:2.52, 95% C.I.:1.10, 5.75). Predictors of general obesity alone were age 41-60 years (AOR:1.84, 95% C.I.:1.14, 2.97), being a female (AOR:7.65, 95% C.I.:4.77, 12.26) and having any form of formal education (AOR:2.55, 95% C.I.:1.10, 5.91). Combined obesity was less likely among 41-60 year-olds (AOR:0.36, 95% C.I.:0.23, 0.56) and females (AOR:0.21, 95% C.I.:0.13, 0.32). Never married (AOR:1.94, 95% C.I.:1.03, 3.67) and vigorous physical activities (AOR:1.81, 95% C.I.:1.08, 3.02) increased the risk of combined obesity by almost 2.ConclusionsPrevalence of abdominal obesity alone, general obesity alone and combined obesity were high. They were functions of age, sex, never married, having any form of formal education, skipping meals, ≥3 daily meal intake and self-reported vigorous physical activity. Focused nutrition and health education are recommended strategies for prevention and control of obesity.

The complex nature of transportation as a key determinant of health in primary and community care restructuring initiatives in rural Canada

It is well recognized that transportation is a barrier to healthcare access for rural-dwelling residents, particularly older adults. Healthcare restructuring initiatives seldom take into consideration the complexity of transportation, which acts as a barrier to appropriate and timely access to healthcare services for older adults in rural communities. This article presents findings of a qualitative research study that explored the complex nature of transportation challenges that rural-dwelling older adults experience in Western Canada when trying to access primary and community care services. Data were derived from a larger study of service user views on a healthcare restructuring initiative intended to facilitate aging-in-place. We conducted 15 focus groups and 9 interviews with a diverse sample of 83 older adults living in one urban centre and nine rural and small rural towns in British Columbia (BC)’s interior. We used content analysis to determine codes and derive themes. Study findings showed that transportation was a top priority for improving primary and community care. Older adult participants identified a range of transportation challenges in trying to get to healthcare services and care providers getting to them. Transportation was a social determinant of health (SDOH) for all participants, regardless of whether they lived in the urban centre or in a rural or small rural town. Our study provides more evidence to support that transportation is a key SDOH for rural-dwelling older adults. As such, transportation should be specifically addressed in healthcare restructuring initiatives that aim to support aging-in-place. Service providers need to advocate for system-wide solutions such as integrating transportation into the healthcare system, while it is imperative that decision-makers act on these solutions.

Reaching Out to Older Adults in Rural Communities by Utilizing Community Health Workers During a Pandemic

Older adults in rural communities have access, isolation, and technology barriers to healthcare that are exacerbated by the COVID- 19 pandemic. A shortage of healthcare professionals combined with limited resources and poor broadband access have limited their ability to benefit from telehealth. The pandemic has further worsened isolation in rural communities. This Age-Friendly Care, PA pilot study uses community health workers (CHW) as a bridge to connect isolated and underserved older adults with their healthcare team. The CHWs facilitate access to telehealth provided by a Federally Qualified Health Center (FQHC), and also provide “check-ins’ to housebound patients. The focus of the intervention is CHW delivered facilitation of telehealth and other supports to better manage their healthcare needs. We will describe the co-design of the project and discuss lessons learned in attempting to bridge the digital divide for rural older adults during and after the pandemic.

Virtual Geriatric Education Preferences of Rural Social Workers

Older adults in rural communities need access to comprehensive healthcare services provided by practitioners equipped with geriatric knowledge and skills. The Geriatric Rural Extension of Expertise through Telegeriatric Service (GREETS) project goal is to use telemedicine and telehealth to expand geriatric service options to underserved Michigan regions. GREETS educational programs train health practitioners to provide geriatric care for vulnerable older adults. To determine gaps in geriatric competencies, the team conducted an online survey of health professionals including behavioral health practitioners. Respondents identified educational topics and preferred virtual delivery methods. Demographic information included respondent’s professional position, practice setting, and county. The respondents were asked to indicate level of educational need using a scale ranging from a low, medium, or high need. Fifty (47%) of 106 total responses were from social workers. We compared the percent of social workers to other practitioners’ responses in our analysis. Four topics emerged for both groups as medium or high educational needs: 1) transitional care when changing residential settings or post-hospitalization; 2) assisting family caregivers cope with caregiving responsibilities; 3) incorporating community-based services into care plans; and 4) and managing frail older adults. Social workers noted higher need than the other respondents for: 1) managing chronic pain; 2) managing care of patients with multiple chronic conditions; 3) having serious illness conversations; 4) diagnosing dementia; and 5) discussing advance care planning. Both social worker and other respondents indicated interactive case-based webinars; published tools, toolkits, tip sheets; and didactic webinars as their top three learning formats.

Navigating Food Insecurity as a Rural Older Adult: The Importance of Congregate Meal Sites, Social Networks and Transportation Services

ABSTRACT To explore how older adults in rural communities navigate food insecurity, ten focus groups were held in Indiana, USA with 65 discussants. Recordings underwent inductive qualitative data analysis. Driving and transport remain a barrier to rural food access. Living alone is another contributor to food insecurity, while older adults’ social networks are protective. Congregate meal sites are critical to maintaining nutrition and are underfunded; one-third of this region’s meal sites closed in 2019. These must be maintained and expanded. Transportation to food outlets is needed. Mechanisms that reinforce older adults’ social networks can build upon an existing asset.

Factors That Influence Physical Activity Among Older Adults Living in Rural Community in Wangthong District, Phitsanulok, Thailand

This study aimed to assess the individual, interpersonal, and environmental factors that relate to physical activity (PA) among older adults in rural communities in Wangthong district, Phitsanulok, Thailand. A cross-sectional study was conducted on 545 elders by multi-stage sampling. The data were collected via a validated questionnaire. Multiple logistic regression analysis was performed to identify potential determinants of PA. Factors including youngest-old (adjusted OR 1.55, 95% CI [1.05–2.28]), high level of income (adjusted OR 1.89, 95% CI [1.17–3.19]), being a member of the elders’ club (adjusted OR 1.68, 95% CI [1.15–2.46]), and high level of perceived self-efficacy (adjusted OR 1.79, 95% CI [1.23–2.61]) indicated higher likelihood of PA ( p &lt; .05). Interventions to improve PA among older people should include improving physical environmental attributes, creating more inexpensive and less time-consuming alternatives for PA, promoting peer support networks and activities to enhance self-efficacy.

English

BACKGROUND Rural populations facing several challenges such as lack of man power, poor accessibility, poverty, illiteracy and many others. Assessment of determinants of oral health becomes essential in developing policies to improve health among such disadvantaged population. The objectives of this study were to develop a Rural Oral Health Determinants (ROHD) tool and identify the determinants of dental caries, gingivitis and periodontitis. METHODS Rural Oral Health Determinants tool was developed based on literature review and expert opinion and its content validity was evaluated. A cross sectional study was carried out among the residents of 206 households in T Hosur village, Karnataka to assess the test–retest reliability and to identify the determinants of dental caries, gingivitis and periodontitis. Data on determinants of oral health were collected using validated ROHD tool and the oral health status was recorded using world health organization (WHO) proforma 2013. Descriptive and Chi square analysis were performed. RESULTS Test retest reliability of ROHD tool as measured by intra-class correlation coefficient ranged from 0.72 - 1. Amongst the various determinants of oral health age, marital status, type of sugar consumption, number of dental visits in the last one year were found to be significantly associated with dental caries. Individuals aged ≥ 36 years and married subjects were more likely to have gingivitis. Periodontitis was strongly associated with age, marital status, education and paternal education. CONCLUSIONS ROHD tool has acceptable validity and reliability and can be used as an effective tool to identify comprehensively the determinants of oral health among adults in rural communities. KEY WORDS Dental Caries, Gingivitis, Oral Health, Periodontitis, Rural Population

The roles of motivational interviewing and self-efficacy on outcomes and cost-effectiveness of a community-based exercise intervention for inactive middle-older aged adults.

Increasing physical activity (PA) among inactive middle-older aged adults in rural communities is challenging. This study investigates the efficacy of a PA intervention supporting inactive adults in rural/semirural communities. Inactive participants enrolled on either a single signposting session (n=427) or a multisession pathway combining signposting with motivational interviewing (MI; n=478). Pre-post outcomes data assessed activity levels (International Physical Activity Questionnaire-Short Form; Single Item Sport England Measure), self-efficacy (New General Self-Efficacy scale [NGSE]) and well-being (five-item World Health Organization Well-Being Index [WHO-5]). Measures were repeated at longitudinal time points (26, 52weeks) for the MI pathway. Outcomes were contrasted with results from an unmatched comparison group receiving treatment as usual (TAU). Cost-utility (quality-adjusted life years [QALY]-incremental cost-effectiveness ratio) and return on investment (NHS-ROI; QALY-ROI) were estimated for short (5years), medium (10years) and long (25years) time horizons. Both pathways significantly increased participants' PA. The MI pathway resulted in significantly greater increases in PA than signposting-only and TAU. Improvements in psychological outcomes (NGSE; WHO-5) were significantly greater in the MI pathway than TAU. Longitudinal results indicated MI pathway participants sustained increases in light-intensity PA at 52weeks (p<0.001; =0.16). Regression analyses found baseline self-efficacy predicted increased PA at 52weeks, while baseline well-being did not. The relationship between self-efficacy and PA increased successively across time points. However, magnitude of participants' increased self-efficacy did not predict PA at any time point. Both pathways were cost-effective and cost -saving for participants aged ≥61years from the short time horizon, with the MI pathway having greater ROI estimates. Overall, MI increased efficacy of a signposting PA intervention and was cost-saving for older adults.

Associations between Individual, Social and Physical Environments and Walking Behavior of Adults in Rural Communities

Associations between Individual, Social and Physical Environments and Walking Behavior of Adults in Rural Communities

Effects of the Older Family Network Program on Improving Quality of Life Among Older Adults in Thailand.

BackgroundThe evidence of promoting family members’ health care for older adults by applying family networks and theory of planned behavior will lead to mental health and lower the quality of life among older adults in rural community in Thailand is unclear.ObjectiveThe study aimed to assess the effects of health promotion among older adults using an aging family network program to reduce depression and improve quality of life (QOL) among older adults.Patients and MethodsThis quasi-experimental study was enrolled on one hundred and ten older adults and their family members. Fifty-five older adult participants joined the health promoting program using family member involvement. This program trained them to change health behaviors such as eating healthy food, exercising, emotion management and disability preventive activities to reduce dementia, stroke and falls. The program was conducted in a rural community for 12 months. A comparison group program conducted usual health promoting activities by health personnel. They evaluated quality of life (QOL) using WHOQOL-OLD measurement, and 30-item geriatric depression scale before implementing interventions and after interventions at 9th and 12th months. Data were analyzed using general linear mixed model analysis.ResultsAfter the intervention, social support and perception of health care from family members were significantly improved at the 9th month. At the 12th month, overall QOL, sensory ability, social participation, intimacy, social support, and perception of health care from family members significantly improved. Depression was also reduced at the 12th month.ConclusionThese findings demonstrated that health promotion using family members improved QOL and reduced depression long term. Policymakers should implement programs to improve QOL among older adults. They need to improve the involvement of family members when conducting health promotion among older adults and support funding due to conduct on weekends or in the evening.

Greater Exposure to a Multilevel Multicomponent Obesity Prevention Intervention in Rural Native American Communities Is Associated With Improved Diet Quality Among Adults

Abstract Objectives Multilevel multicomponent (MLMC) intervention trials attempt to reach participants in many different settings in their lives to promote environmental and behavioral change; however, individual-level exposure to these complex interventions has rarely been evaluated. We examined the association between exposure to an MLMC intervention and changes in diet quality among Native American adults in rural communities in the Midwest and Southwest U.S. Methods The OPREVENT2 intervention was implemented over 18 months in three reservation-based communities, in the first round of the study. Nutrition and physical activity messages were delivered in local food stores, worksites, schools, and by social and community media, along with changes to food store and workplace environments to support increased physical activity and healthier food choices. A Block Food Frequency Questionnaire (FFQ) was used to calculate a Healthy Eating Index (HEI-2015) score at baseline and follow-up. At follow-up, 234 adults self-reported their exposure to intervention materials and activities via an 81-item questionnaire with illustrations. Exposure scores for each intervention component were calculated and weighted by level of interactiveness (e.g., taste tests were most interactive; posters least interactive), then summed yielding a total exposure score. Linear regression models assessed change in HEI score by participant exposure (component and total), controlling for baseline sociodemographic variables. Results The participants were majority female (73%) with a mean age of 44 (±14) years and mean total exposure score of 11.66 ± 6.71 on a scale of 0–28. Participants with higher total exposure scores had a greater increase in HEI scores compared to those who were least exposed to the intervention (b = 3.61 ± 1.90, P = 0.049). Improved diet quality was also positively associated with exposure to specific intervention components, including educational displays, posters, and radio announcements (P &amp;lt; 0.01). Conclusions We found a dose-response relationship between level of exposure to the intervention and diet quality among participants in the OPREVENT2 intervention. Future MLMC interventions in NA rural communities should consider using radio announcements, posters, educational displays to engage with adults and promote healthy eating. Funding Sources NHLBI.

Functional status and its associated factors among community-dwelling older adults in rural Nepal: findings from a cross-sectional study

BackgroundThe high burden of chronic conditions, coupled with various physical, mental, and psychosocial changes that accompany the phenomenon of aging, may limit the functional ability of older adults. This study aims to assess the prevalence of poor functional status and investigate factors associated with poor functional status among community-dwelling older adults in rural communities of eastern Nepal.MethodsData on 794 older adults aged ≥ 60 years from a previous community-based cross-sectional study was used. Participants were recruited from rural municipalities of Morang and Sunsari districts of eastern Nepal using multi-stage cluster sampling. Functional status was assessed in terms of participants’ ability to perform activities of daily living using the Barthel Index. Covariates included sociodemographic characteristics, lifestyle factors, and self-reported chronic conditions. A binary logistic regression model was used to investigate factors associated with poor functional status.ResultsThe overall prevalence of poor functional status was 8.3 % (male: 7.0 % and female: 9.6 %), with most dependence noted for using stairs (17.3 %), followed by dressing (21.9 %) on Barthel Index. In the adjusted model, oldest age group (odds ratio [OR] = 2.83, 95 %CI: 1.46, 5.50), those unemployed (OR = 2.41, 95 %CI: 1.26, 4.65), having memory/concentration problems (OR = 2.32, 95 %CI: 1.30, 4.13), depressive symptoms (OR = 2.52, 95 %CI: 1.28, 4.95), and hypertension (OR = 1.78, 95 %CI: 1.03, 3.06) had almost or more than two times poor functioning.ConclusionsOne in 12 older adults had poor functional status as indicated by their dependency on the items of the Barthel Index; those in the oldest age bracket were more likely to exhibit poor functional status. We suggest future studies from other geographies of the country to supplement our study from the rural setting for comprehensive identification of the problem, which could guide the development of prevention strategies and comprehensive interventions for addressing the unmet needs of the older adults for improving functional status.

Moderated mediation roles of social connectedness and optimism on emotional intelligence and life satisfaction

The processes and circumstances underlying the association between emotional intelligence and life satisfaction were investigated among rural older adults. The factor structure of the measures was also assessed to determine their capacity and suitability for use. Participants were 1053 (639 males and 414 females) older adults with a mean age of 71.34 (SD of 7.15) recruited from selected rural communities in southwestern Nigeria. Results of the factor analysis show that the measures are appropriate for use in the study settings. Emotional intelligence significantly predicts life satisfaction as a result of social connectedness among the samples used. Also, the effect holds better among older adults with higher dispositional optimism than those with lower dispositional optimism. The study outcomes underscore the importance of social connectedness and optimism on life satisfaction among older adults in rural communities.

Rural-urban differences in diagnostic incidence and prevalence of Alzheimer's disease and related dementias.

Understanding rural-urban variation in the diagnostic incidence and prevalence of Alzheimer's disease and related dementias (ADRD) will inform policies to improve timely diagnosis and access to supportive services for older adults in rural communities. Using 2008 to 2015 national claims data for fee-for-service Medicare beneficiaries (roughly 170 million person-years), we computed unadjusted and adjusted diagnostic incidence and prevalence estimates for ADRD in metropolitan, micropolitan, and rural counties, and examined differences in survival rates. Risk-adjusted ADRD diagnostic incidence was higher in rural versus metropolitan counties despite lower prevalence. Among beneficiaries diagnosed with ADRD in 2008, metropolitan county residents experienced longer survival compared to residents in rural and micropolitan counties. These data suggest that older adults in rural communities may be underdiagnosed with ADRD, and/or diagnosed at later stages of dementia. Further work is needed to develop strategies to reduce this disparity.

Preventive health care services utilization and its associated factors among older adults in rural communities in Anambra State, Nigeria.

Introductionquality of life and life expectancy of people are improved when preventive health care services are utilized because these identify treatable health problems and puts life-threatening diseases in check. Morbidity and mortality associated with age-related chronic disease among the older adults is on the increase, therefore, this study aims at determining preventive health care services utilization among older adults in rural communities in Anambra State.Methodsa cross sectional design adopted for this study was carried out on older adults from the ages of 65 years and above in rural communities in Anambra State from October 2019 to January 2020. Data were collected through researcher-administered structured questionnaire. Data were analysed using univariable and multivariable regression analysis.Resultsa total of 1944 older adults participated with an overall cluster percentage of 40.6% older adults utilizing investigated preventive health care services. The results of the multivariable analysis indicates that the following factors were associated with utilization of preventive healthcare services: male gender (aOR: 0.443, 95%CI: 0.281 - 5.472, p=0.47), level of education; primary (aOR: 1.536, 95%CI: 1.201 - 5.261, p=0.00), secondary (aOR: 4.516, 95%CI: 3.192 - 6.242, p=0.00), and tertiary (aOR: 3.407, 95%CI: 3.199 - 5.666, p=0.00)], income of N50,000-N100,000 (aOR: 2.754, 95%CI: 1.066 - 10.766, p=0.01), and N100,000 and above (aOR: 4.233, 95%CI: 1.846 - 12.811, p=0.00)], and health insurance [aOR: 0.691, 95%CI: 0.422 - 1.945, p=0.03].Conclusionpreventive health care services were under-utilized. Creating awareness on the importance of utilizing preventive health care services is highly recommended since most age-related chronic diseases once established may last a lifetime and affect quality of life and wellbeing.

Prevalence of Hypertension and Its Risk Factors among Adults in Rural Community: A Cross-Sectional Study

Introduction: Hypertension is a chronic condition of concern due to its role in the causation of coronary heart disease, stroke and other vascular complications. Objectives of this study were to find out prevalence of hypertension among adults of rural community and association between hypertension and its risk factors.&#x0D; Methodology: Cross sectional community-based study was done with a sample of 501 adults between 18 to 60 years of age including both men (244) and women (257). A pretested semi-structured proforma was used collect data by trained doctors.&#x0D; Results: The overall prevalence of hypertension was found to be 32.13 %. Higher prevalence found among males (34%), age group 51-60 year (49.5%) and in class III SES (38.9%). Hypertension was found to be significantly associated with family history of hypertension (OR=2.41, CI= 1.50-3.80), smoking (OR= 1.78, CI=1.08-2.93), alcohol use (OR=1.8, CI=1.20-2.60), high salt intake (OR= 3.2, CI=1.80-5.45), junk food consumption (OR=2.40, CI=1.63-3.52), physical inactivity (OR=2.8, CI=1.90-4.14), overweight (OR=3.14, CI=2.11-4.66) and obesity (OR=3.78, CI=2.41-5.95).&#x0D; Conclusion: Increasing prevalence of hypertension in rural areas is major public health problem. Appropriate strategies are needed to create awareness regarding risk factors of hypertension.

Significant Association between Physical Performance and Inflammatory Biomarkers in Older Adults with Frailty in Rural Thailand

Background: The etiology of frailty is complex and incompletely understood, and is associated with alterations in the immune system, resulting in chronic low-grade inflammation. However, few studies have explored the inflammatory biomarkers related to physical performance in the elderly. Methods: We evaluated the prevalence of frailty with a cross-sectional study among older adults in rural communities in Thailand (n = 457, mean age of 71.4 ± 5.8 years) with Fried’s frailty phenotype including five criteria: weight loss, exhaustion, slowness, weakness, and inactivity. The association between inflammatory biomarkers (serum interleukin-6, IL-6 and C-reactive protein, CRP levels) and physical performance (grip strength, walk times and VO2Max) was examined in frail participants (n=64). Results: The prevalence of frailty and pre-frailty in this population was 37.4% (95% CI, 32.9-42.0) and 54% (95% CI, 49.4-58.7). Multiple linear regression analysis found that serum IL-6 level was significantly elevated in frail older adults with low grip strength (beta = -0.348, SE= 0.155, p = 0.029). Serum CRP level was also elevated significantly in frail older adults with low grip strength (beta = -0.049, SE= 0.023, p = 0.04) and low VO2Max (beta = -0.047, SE= 0.019, p = 0.016) after adjustment for sex, age, hypertension, diabetes, osteoporosis, heart disease, and BMI. Conclusion: Our findings support a low level of grip strength as predictor of inflammatory biomarkers in older adults with frailty. Primary care practitioners could use frailty indicators and performance combined with serum biomarkers for early health risk detection in older adults.

The Impact of the COVID-19 Epidemic on Older Adults in Rural and Urban Areas in Mexico.

ObjectivesMexico is among the countries in Latin America hit hardest by coronavirus disease 2019 (COVID-19). A large proportion of older adults in Mexico have high prevalence of multimorbidity and live in poverty with limited access to health care services. These statistics are even higher among adults living in rural areas, which suggest that older adults in rural communities may be more susceptible to COVID-19. The objectives of the article were to compare clinical and demographic characteristics for people diagnosed with COVID-19 by age group, and to describe cases and mortality in rural and urban communities.MethodWe linked publicly available data from the Mexican Ministry of Health and the Census. Municipalities were classified based on population as rural (<2,500), semirural (≥2,500 and <15,000), semiurban (≥15,000 and <100,000), and urban (≥100,000). Zero-inflated negative binomial models were performed to calculate the total number of COVID-19 cases, and deaths per 1,000,000 persons using the population of each municipality as a denominator.ResultsOlder adults were more likely to be hospitalized and reported severe cases, with higher mortality rates. In addition, rural municipalities reported a higher number of COVID-19 cases and mortality related to COVID-19 per million than urban municipalities. The adjusted absolute difference in COVID-19 cases was 912.7 per million (95% confidence interval [CI]: 79.0–1746.4) and mortality related to COVID-19 was 390.6 per million (95% CI: 204.5–576.7).DiscussionUrgent policy efforts are needed to mandate the use of face masks, encourage handwashing, and improve specialty care for Mexicans in rural areas.

Abdominal obesity is associated with arterial stiffness and carotid IMT in middle-aged, elderly rural community adults

Abdominal obesity is associated with arterial stiffness and carotid IMT in middle-aged, elderly rural community adults