The Rural Health Domain Team seeks to understand the epidemiology, utilization, treatment, and outcomes of the COVID-19 pandemic in rural communities. The overarching goal is to develop better evidence for potential differences in the COVID-19 epidemic response and outcomes for rural health care centers and rural dwellers. Studying the at-risk populations and unique challenges faced by rural communities during and after the pandemic may provide opportunities for improving rural health and health care.
a) Epidemiology – Duration of COVID-19 testing, infection, hospitalization, and death rates among rural dwellers will be compared to the closest urban dwellers and with the overall national pandemic. Health conditions such as obesity, diabetes, cardiovascular diseases, cancer, infectious diseases, chronic obstructive pulmonary diseases, maternal health, and substance overuse disorders are disproportionally prevalent in rural areas. The co-morbidity profiles of those tested, infected, and deceased will be compared as a function of rurality by zip code and population density.
b) Utilization – Testing, outpatient visits, emergency room visits, and hospitalization rates will be estimated based on known zip code population weights. These will be compared as functions of rurality and calendar date. Centers will be classified by immediate and surrounding zip code population densities. Rural healthcare facilities tend to have fewer financial and human resources, less access to medical supplies and testing opportunities, less connectivity to support telehealth services, and less capacity to balance fluctuating patient loads. If feasible, rates of hospital-to-hospital will be estimated as a function of center and patient rurality.
c) Treatments – Application of treatments including remdesivir, mechanical ventilation, and ECMO will be compared by rurality of centers and patients adjusted for available measures of severity of illness at presentation and for background co-morbidities.
d) Outcomes – COVID-19-related death rates will also be compared by rurality of centers and patients adjusted for available measures of severity of illness at presentation and for background co-morbidities.