Analysis: K.M. Johnson, Carsey School of Public Policy, University of New Hampshire

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UPDATE: The Carsey School of Public Policy released an updated version of Kenneth Johnson’s research brief April 18.

America’s rural population is more vulnerable to complications from COVID-19. That’s because rural residents tend to have more of the health conditions and demographic characteristics that can lead to medical difficulties from coronavirus infections.

Journalists (including those at the Daily Yonder) and researchers have produced numerous reports that have raised this concern.

Now, for the first time to our knowledge, a researcher has put some numbers to this general finding. This research confirms that rural Americans should be taking the pandemic very seriously.

Kenneth Johnson, senior demographer at the Carsey School and a sociology professor at the University of New Hampshire, looked at the impact of age on the potential death rate in each county in the United States. (Here’s the full research brief, revised April 18.)

He found that more than half of the nation’s nonmetropolitan (or rural) counties would have significantly higher death rates among those infected than the nation as a whole. In contrast, only 22% of metropolitan counties would have such high death rates.

Before we get to details of the study, including some important limitations, let’s just repeat the crux of what Johnson found: Among those who contract COVID-19, rural counties are likely to have higher death rates than metropolitan counties or the nation as a whole because of their age structure. It is a sobering conclusion.

Now, some details.

First, Johnson’s study is not intended to calculate an actual death rate from COVID-19 for each county in America. Rather, it estimates the relative impact that age could have on the county coronavirus death rate. The question is not how many people will die from the infection. Rather, when people get infected, how will the local age structure make some counties likelier to have more deaths, relative to other counties?

Second, the study is based on the death rate of people who contract COVID-19, not the overall death rate of the population from the pandemic. If rural communities keep the infection rate lower, obviously there will be fewer hospitalizations and deaths in rural areas. What this tells us is that rural communities have a very big incentive to reduce the rate of transmission. Because if they don’t, the results are more likely to be grim.

To produce the study, Johnson used age-based COVID-19 mortality rates published in the Lancet on March 30. He combined that research with county-level Census population and age figures to create an index of counties based on the likely impact of the virus on death rates. Again, what he found is that rural counties are more likely to land on the worse end of the spectrum.

Johnson looked only at the impact that age might have on county death rates of people infected with the coronavirus. There are many other factors, primarily preexisting conditions such as heart and lung disease, diabetes, high blood pressure, and cancer, as well as access to health care. A more comprehensive study of the relative death rates from COVID-19 by county would require looking at each of factors. If such a study were undertaken, however, we can’t imagine much good news in it for rural America. People who live in rural areas are also more likely to have many of the other conditions that contribute to COVID-19 mortality.

The number of cases and deaths caused by the coronavirus is changing rapidly. So far, rural America has a lower infection rate than the nation overall. We’ve noted important exceptions to this rule. It’s clear that COVID-19 doesn’t stop at the city limits or the county line. Johnson’s research shows us how much is at stake for rural communities and other vulnerable populations if we don’t prevent the spread.