CDC Finds Urban-Rural Disparity in COVID-19 Vaccinations

A county-level study of COVID-19 vaccination rates conducted by the CDC reveals substantially lower rates in rural areas than in urban, and the investigators call for outreach efforts in these communities to increase vaccine access and acceptance.

"As availability of COVID-19 vaccines expands, pubic health practitioners should continue collaborating with health care providers, pharmacies, employers, faith leaders, and other community partners to identify and address barriers to COVID-19 vaccination in rural areas," Bhavini Patel Murthy, MD, Immunization Services Division, National Center for Immunization and Respiratory Diseases, CDC, stated.

In the period between December 14, 2020 and April 10, 2021, the rate of vaccination among adults was 45.7% in urban counties, and 38.9% in rural counties. Although this disparity between urban and rural counties held across age and gender, women had higher rates of vaccination (41.7% rural, 48.4% urban) than men (35.3% rural, 41.9% urban).In addition, those ≥65 years of age had higher vaccination rates (67.6% rural, 76.1% urban) than younger adults (29.1% rural, 37.7% urban).

The analysis did not include race and ethnicity because these data were missing from 40% of the collected records.

The investigators posited that women have a higher rate of vaccination because they are more likely to seek and use preventive care services, and/or that more women work in sectors such as health care and education that prioritized early vaccination. They attribute the higher rate of vaccination in older adults to eligibility criteria that prioritized older adults earlier in the implementation of the vaccination program.

The vaccination and demographic data were gathered in 49 US states and the District of Columbia (DC) from the immunization information systems (IISs), the Vaccine Administration Management System, and from direct data submission.The State of Hawaii was excluded, as were 8 counties in California with <20,000 residents, as these have data-sharing restrictions on county-level information reported to the CDC.

Although the vaccination rates were generally lower in rural than urban areas, the investigators found vaccination rates that were similar between urban and rural counties in 5 states, and rates in rural counties that surpassed that of urban counties in 5 other states.

Murthy and colleagues suggest that this finding, against the trend, could have been influenced by several initiatives, including "implementing tailored approaches based on local needs, partnering with local community-based organizations and faith leaders, and engaging with underserved populations directly and through partners."

The investigators emphasize that vaccine hesitancy in rural areas has been found to be a major obstacle to achieving necessary rates of vaccination.They cite one recent poll by the Kaiser Family Foundation, conducted in March 2021, that found 21% of rural residents state that they would "definitely not" get a vaccine, compared with 10% of urban residents.Another recent Kaiser Family Foundation poll found, Murthy and colleagues note, that 86% of rural residents report that they trust their own health care providers for information on COVID-19 vaccines--suggesting that their public health practitioners have an important role in conveying the science and necessity of vaccination.

"Disparities in COVID-19 vaccination between urban and rural communities can hinder progress toward ending the pandemic," Murthy declared. "Focused, multi-partner efforts can help increase nationwide vaccination coverage and reduce morbidity and mortality from COVID-19."