Health service inequalities during the COVID-19 pandemic among elderly people living in large urban and non-urban areas in Florida, USA

Abstract

Objective: Health inequalities were often exacerbated during the emerging epidemic. This study examined urban and non-urban inequalities in health services among COVID-19 patients aged 65 years or above in Florida, USA, from 2 March to 27 May 2020. Methods: A retrospective time series analysis was conducted using individual patient records. Multivariable Poisson’s and logistic models were used to calculate adjusted incidence of COVID-19 and the associated rates of emergency department visits, hospitalizations, and deaths. Results: As of 27 May 2020, there were 13,659 elderly COVID-19 patients (people aged 65 years or above) in Florida and 14.9% of them died. Elderly people living in small metropolitan areas might be less likely to be confirmed with COVID-19 infection than those living in large metropolitan areas. The emergency department visit and hospitalization rates decreased significantly across metropolitan statuses for both men and women. Those patients living in small metropolitan or rural areas were less likely to be hospitalized than those living in large metropolitan areas (35% and 34% vs 41%). Elderly women aged 75 years or above living in rural areas had 113% higher adjusted incidence of COVID-19 than those living in large metropolitan areas, and the rates of hospitalizations were lower compared with those counterparts living in large metropolitan areas (29% vs 46%; odds ratio: 0.37 (0.25–0.54), p < 0.001). Conclusion: For elderly people living in Florida, USA, those living in small metropolitan or rural areas were less likely to receive adequate health care than those living in large or medium metropolitan areas during the COVID-19 pandemic.

Rural-urban outcome differences associated with COVID-19 hospitalizations in North Carolina

“…Remaining rural hospitals need resources and in areas where closures have occurred or no rural hospitals exist, alternative systems for emergency and acute care should be prioritized. Many rural hospitals were unequipped to manage surges in infectious patients [ 62 , 66 ]. Relatedly, there needs to be efforts to speed transfer of severe cases to urban hospitals.…”

“…The US experienced 181 rural hospital closures in the 15 years prior to the pandemic [ 74 ]. Continued closure of rural hospitals would further concentrate health care facilities in large cities [ 62 ] and exacerbate existing barriers to healthcare access.…”

“…This study contributes to the existing literature on health disparities in the United States by providing evidence of rural-urban health outcome differences related to COVID-19. Health inequalities for each of these groups with disproportionate disease burdens may be due to differences in socioeconomic status (SES) [62]. People with lower SES are more likely to have higher rates of comorbidities and limited access to health care resources [62][63][64].…”

“…Health inequalities for each of these groups with disproportionate disease burdens may be due to differences in socioeconomic status (SES) [62]. People with lower SES are more likely to have higher rates of comorbidities and limited access to health care resources [62][63][64]. Taken together, the rural-urban differences in SES and healthcare resources, which elsewhere have been called structural urbanism [20], should be viewed as important predictors of COVID-19 outcomes and evidence for policy changes addressing these differences.…”

Elder abuse and hospitalization in rural Malaysia

“…The Poisson model is a useful methodology for count data, such as the yearly rate of hospitalization. Poisson regression is widely used to evaluate the effect of various treatments or risk factors on hospitalization rates [34][35][36][37]. All the assumptions of selected statistical tests were checked prior to running the analyses and the statistical significance value was set at 0.05.…”