Urban-rural differences in COVID-19 exposures and outcomes in the South: A preliminary analysis of South Carolina

Abstract

As the COVID-19 pandemic moved beyond the initial heavily impacted and urbanized Northeast region of the United States, hotspots of cases in other urban areas ensued across the country in early 2020. In South Carolina, the spatial and temporal patterns were different, initially concentrating in small towns within metro counties, then diffusing to centralized urban areas and rural areas. When mitigation restrictions were relaxed, hotspots reappeared in the major cities. This paper examines the county-scale spatial and temporal patterns of confirmed cases of COVID-19 for South Carolina from March 1st—September 5th, 2020. We first describe the initial diffusion of the new confirmed cases per week across the state, which remained under 2,000 cases until Memorial Day weekend (epi week 23) then dramatically increased, peaking in mid-July (epi week 29), and slowly declining thereafter. Second, we found significant differences in cases and deaths between urban and rural counties, partially related to the timing of the number of confirmed cases and deaths and the implementation of state and local mitigations. Third, we found that the case rates and mortality rates positively correlated with pre-existing social vulnerability. There was also a negative correlation between mortality rates and county resilience patterns, as expected, suggesting that counties with higher levels of inherent resilience had fewer deaths per 100,000 population.

Spatial Disparities of COVID-19 Cases and Fatalities in United States Counties

“…There were higher numbers of mitigation measures in urban areas, which also contained lower rates of standardized cases and fatalities. Our study confirms previous research investigated over a smaller geographic area that found increased standardized cases and fatalities in rural US counties [13], but contradicts a nationwide study executed earlier in the pandemic finding higher mortality rates in urban counties [30].…”

“…Urban-rural disparities explored in earlier research found increased mortality rates [30] and higher prevalence rates of COVID-19 infection in urban counties [12]. Another study found higher standardized cases and fatalities in rural counties in just one US state [13], while others found severe negative impacts of the pandemic on rural unemployment and economic wellbeing [10]. Not only do rural residents have higher positive COVD-19 testing rates [26] and fewer hospitalization resources available for affected patients [31,32], but locational disparities exist in testing access and pandemic messaging in rural locations [33].…”

“…We employed Spatial Scan Statistic (SaTScan) version 9.7 (SaTScan, Boston, MA, USA) for space-time cluster analyses of COVID-19 cases and fatalities across the contiguous US with Poisson and space-time prospective/retrospective models [13,23,28,29]. The removal of Hawai'i and Alaska was necessary for the space-time analysis due to contiguity requirements and coordinates for cases/fatalities were assigned based on the centroids of counties.…”

“…Only recently has there been a focus on place, or what Perry et al [9] term the precarity of place, in addition to urban-rural influences on COVID-19 experiences [10]. Research has mostly examined the geography of COVID-19 risk based on individual-level factors (e.g., social determinants of health) or community-based elements (e.g., resilience, social vulnerability, or public health mitigation measures) over a short study period or wave of the pandemic [11,12], or in specific sub-national areas [9,13,14]. Thus far, there has not been a longer-term (year-long) study for the US examining the spatial and temporal county-level variability in COVID-19 cases and fatalities that considers several influential elements of social context or measurements of pre-emergent economic recovery.…”

Field Evidence of the Effects of Pro-sociality and Transparency on COVID-19 App Attractiveness

“…Finally, we examine the impact of geography on willingness to click on ads for CovidDefense. In contrast to the existing body of literature around urban-rural differences in COVID-19 behavior, which finds that rural residents are less concerned about COVID-19 and less likely to adopt pro-social COVID-19 behaviors [27,28,29,30], we find that Louisiana residents in rural communities are significantly more likely to click on any of the proposed ads (O.R. = 1.15; p < 0.001; Appendix Table 6).…”