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COVID-19 Resource Center

Disclosures: The authors report no relevant financial disclosures.
May 18, 2021
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COVID-19 vaccination coverage lower in rural communities

Disclosures: The authors report no relevant financial disclosures.
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COVID-19 vaccination coverage is almost seven percentage points lower in rural U.S. counties compared with urban counties, researchers found — a disparity they said could hinder progress toward ending the pandemic.

“Because residents of rural communities are at increased risk for severe COVID-19-associated illness and death, vaccination disparities between urban and rural areas might hinder efforts to reduce morbidity and mortality from COVID-19 nationally,” Bhavini Murthy, MD, MPH, a medical epidemiologist for the CDC, and colleagues wrote in MMWR.

COVID-19 vaccination graphic
Source: Murthy BP, et al. MMWR Morbid Mortal Wkly Rep. 2021;doi:10.15585/mmwr.mmmm7020e3.

“Public health practitioners should continue collaborating with health care providers, pharmacies, community-based organizations, faith leaders and local employers to address vaccine hesitancy and ensure equitable vaccine access and distribution, particularly in rural areas” they wrote. “These focused, multipartner efforts can help increase nationwide vaccination coverage and reduce morbidity and mortality from COVID-19.”

Murthy and colleagues analyzed county-level vaccine data reported between Dec. 14, 2020, and April 10, 2021, from adults aged 18 years or older who had received the first dose of either the Pfizer-BioNTech or Moderna vaccine or a single dose of the Johnson & Johnson vaccine.

They examined differences in vaccination coverage between urban and rural communities, which often have a higher proportion of people living with comorbidities, people aged 65 years or older, people with limited access to health care facilities with intensive care, and people who lack health insurance.

The researchers found that COVID-19 vaccination coverage was 38.9% in rural counties and 45.7% in in urban counties. The disparity in vaccination coverage between rural and urban citizens persisted in persons aged 18 to 64 years (29.1% vs. 37.7%), persons aged 65 years and older (67.6% vs. 76.1%), women (41.7% vs. 48.4%) and men (35.3% vs. 41.9%).

Limitations of the analysis included county of residence not being available for 9.2% of people, jurisdictions prioritizing population subgroups differently, changing vaccine supply during the course of the analysis, urban-rural classification status being potentially outdated, and race and ethnicity not being included for 40% of persons.

“Improved data completeness is critical to measure and address racial and ethnic disparities in vaccination coverage,” the authors wrote.