Illustration Credit: Xandr Brown (photos by Unsplash)

A new study on Covid-19 mortality rates found that rates were at their highest in the Midwest, and in areas with larger populations of Hispanic or American Indian/Alaska Native populations.

The study from the Rural Health Research & Policy Centers looked at Covid mortality rates in December 2020 and January 2021, when Covid deaths were at their peak and vaccines were not widely available. The study looked at how different geographic and demographic factors may have affected deaths. It compared rates in three types of counties: metropolitan (counties in a market area that contains a city of at least 50,000 residents), micropolitan (counties that are in a market area with a city of 10,000 to fewer than 50,000), and non-core (counties that have no cities of 10,000 or more residents and aren’t part of a metropolitan or micropolitan market).

The study looked at nearly 179,000 Covid deaths across the country. Of those, 142,950 deaths occurred in metropolitan counties for a mortality rate of 51.64 deaths per every 100,000 residents. In non-core counties, there were only 15,711 deaths. However, the population density of those areas meant the mortality rate reached 83.37 deaths per 100,000 — nearly two-thirds higher than the metropolitan counties.

Covid mortality rates were the highest in the Midwest with 63.94 deaths per 100,000 over all, but rose to 94.24 deaths per 100,000 in non-core counties.

What the study found, Whitney Zahnd, one of the lead researchers, said in an interview with the Daily Yonder, was that Covid deaths were highest in more isolated communities. While those counties were initially thought to be more protected because of their isolation, the high death rates may reflect the limited capacity of their health care systems. Higher numbers of elderly people and higher rates of other health factors – like diabetes, respiratory illnesses and obesity – also contributed to Covid deaths, the study found.

“We did find in this two month time period… that with increasing isolation, there were higher rates of death,” Zahnd said.

Areas with more nursing home beds also saw higher rates of Covid deaths during the two months the study covered. While that was true in urban and suburban areas, in rural areas, counties with the highest rates of nursing home bed density also saw the highest mortality rates, the study found. 

Zahnd said more research is needed as to why deaths were higher in those areas.

Learning why deaths in rural nursing home settings were higher, researchers said, will help prevent future deaths in similar situations by informing health care operators on how to implement adequate infection monitoring and isolations procedures, and how to protect residents and staff through suitable staffing policies.

“I wish I had a really elegant, nice, nice answer for (why),” she said. “It’s a very complicated set of factors.”

The higher mortality rates could be influenced by occupations in those areas, like meat processing or manufacturing, that put residents in closer contact with others, she said. Or it could be because of a tendency for those populations to have multiple generations living in the same house.

“That’s a role that’s not something that’s necessarily rural specific,” she said. “It’s a very complicated set of factors, but we also know there’s the element of the healthcare system (in rural areas) that is a factor.”

Limited staffing, limited ICU beds or the need to transfer seriously ill patients to other facilities at rural health care systems could be those factors, she said.

One thing the study shows, she said, is that more research is needed to determine what happened and how to prevent it from happening again.

“I think it’s really important to understand the ongoing pandemic during the early first year so we can make sure the healthcare system, particularly in rural areas, is prepared for other pandemics and other crises where there’s an acute need for health care services,” she said.”

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