1. Rural-Urban Disparities in Hospital Admissions and Mortality Among Patients with COVID-19: Evidence from South Carolina from 2021 to 2022.
- Author
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Giannouchos, Theodoros V., Li, Zhenlong, Hung, Peiyin, Li, Xiaoming, and Olatosi, Bankole
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COVID-19 , *CONFIDENCE intervals , *SOCIAL determinants of health , *MULTIPLE regression analysis , *PATIENTS , *POPULATION geography , *HOSPITAL admission & discharge , *HOSPITAL mortality , *RISK assessment , *DESCRIPTIVE statistics , *RESEARCH funding , *HEALTH equity , *ODDS ratio , *RURAL population - Abstract
Although rural communities have been hard-hit by the COVID-19 pandemic, there is limited evidence on COVID-19 outcomes in rural America using up-to-date data. This study aimed to estimate the associations between hospital admissions and mortality and rurality among COVID-19 positive patients who sought hospital care in South Carolina. We used all-payer hospital claims, COVID-19 testing, and vaccination history data from January 2021 to January 2022 in South Carolina. We included 75,545 hospital encounters within 14 days after positive and confirmatory COVID-19 testing. Associations between hospital admissions and mortality and rurality were estimated using multivariable logistic regressions. About 42% of all encounters resulted in an inpatient hospital admission, while hospital-level mortality was 6.3%. Rural residents accounted for 31.0% of all encounters for COVID-19. After controlling for patient-level, hospital, and regional characteristics, rural residents had higher odds of overall hospital mortality (Adjusted Odds Ratio – AOR = 1.19, 95% Confidence Intervals – CI = 1.04–1.37), both as inpatients (AOR = 1.18, 95% CI = 1.05–1.34) and as outpatients (AOR = 1.63, 95% CI = 1.03–2.59). Sensitivity analyses using encounters with COVID-like illness as the primary diagnosis only and encounters from September 2021 and beyond – a period when the Delta variant was dominant and booster vaccination was available - yielded similar estimates. No significant differences were observed in inpatient hospitalizations (AOR = 1.00, 95% CI = 0.75–1.33) between rural and urban residents. Policymakers should consider community-based public health approaches to mitigate geographic disparities in health outcomes among disadvantaged population subgroups. [ABSTRACT FROM AUTHOR]
- Published
- 2023
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