Since the first wave of the pandemic, when the urban death rate was three times higher than the rural death rate, the trend has reversed. The rural and urban death rates were roughly equal during the second wave. In the third wave, the rural death rate was 50% higher than the urban rate. Since July 2021, the rural death rate has been 100% higher than the urban death rate. (Daily Yonder based on USA Facts, CDC, OMB)

For 66 out of the last 71 weeks, rural Americans have been dying of Covid-19 at higher rates than metropolitan Americans. Most recently, the rural death rate has been two times higher than the metropolitan rate.

The pandemic didn’t start this way. The first wave was primarily an urban phenomenon. But in each of the ensuing three waves, the rural rate has exceeded the urban rate. And with each wave, the rural disparity has become more pronounced.

To accompany Liz Carey’s story exploring the causes of the high rural death rate, I dug into data going back to March 2020. Here are four charts that show patterns in Covid-19 deaths throughout the pandemic. (To explore the likely causes of this patterns, see Liz’ article.)

Chart 1: Raw Number of Deaths

The chart above shows the weekly number of Covid-19 deaths in metropolitan and rural counties. These are raw numbers, so rural deaths are much lower than urban deaths, since rural America constitutes less than a fifth of the U.S. population.

Chart 2: Rates of Death

To see what’s happening within a group, we can use rates to compare the relative impact on differently sized populations. Above is a graph of weekly death rates for metro and rural counties, expressed as the number of deaths per 100,000 residents.

The initial wave in spring 2020 was primarily urban, so the urban death rate (the blue line) spiked without a parallel rise in the rural death rate (the red line). In the second wave, the death rates were parallel until the rural rate exceeded the metro rate in August. From that point on, the weekly rural death rate exceeded the urban rate for all but five weeks. After several months of being roughly equal, the rural death rate diverged from the urban rate sharply at the start of the fourth wave in July 2021. This was the first wave to occur after Covid-19 vaccines became broadly available.

Chart 3: Rates of Death for Each Wave

(See top of this article or click for larger version of this chart.)

In this graph (which is also at the top of this article), we’ve calculated the death rate for rural and metropolitan counties for each of the four waves of the pandemic. This shows how the rural death rate became relatively worse compared to the metro rate in each successive wave. The first wave was primarily urban. The second wave affected rural and metropolitan counties about the same. But the third wave in winter of 2020-21 saw the rural rate outstrip the metro rate by nearly 50%. In the fourth wave, the rural rate soared to twice that of urban areas.

Chart 4: Rate's Extra Death Toll

So what does this all mean? The following graph shows the cumulative number of rural people who, statistically speaking, died because the rural death rate was higher than the metropolitan one.

This is a huge “what if.” But it does provide a statistical bottom line of the human toll exacted by the higher rural death rate. An estimated 47,000 fewer people would have died from Covid-19 in the last 16 months if the rural death rate had been as low as the metropolitan rate. That’s a third of the approximately 140,000 rural Americans who have died of Covid-19.

Conversely, if metropolitan counties had experienced the same death rate as rural counties, an additional 288,000 Covid-related deaths would have occurred.

Either way, the numbers are big. And they are especially sobering as we confront the possibility of a fifth wave of Covid-19 from the Omicron variant.

Tim Marema is editor of the Daily Yonder.

Data for this report comes from USA Facts and the Centers for Disease Control and Prevention. Rural is defined as nonmetropolitan counties, which are counties not included in a Metropolitan Statistical Area (Office of Management and Budget, 2013).

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