The Compounding Effect of Rurality on Health Disparities Among Black Patients with COVID-19.

Background: West Virginia had garnered national attention for its vaccination rollout against coronavirus 2019 (COVID-19). Outcomes of this mostly rural population, however, have been underreported. As the pandemic continues, identifying high risk populations remains important to further epidemiologic information and target vaccines.

Purpose: The objective of this study is to examine the effects of COVID-19 and the influence of race and rurality on hospitalization and outcomes in Appalachians.

Methods: In this retrospective study, data from patients who tested positive and were admitted for COVID-19 and seen within the state's largest health system (West Virginia University Health System) between March 18 and September 16, 2020 were analyzed. Cases were stratified into rural or urban based on rural urban continuum codes (RUCCs) and by race into 'white,' 'black,' or 'other.' Associations between rurality, rurality and race, and outcomes were assessed.

Results: A total of 2011 adult West Virginians tested positive, of which 8.2% were hospitalized. Of the hospitalized patients, 33.5% were rural and 11.6% were black. Rural black patients were three times more likely (OR: 3.33; 95%CI:1.46-7.60) to be admitted. Rural blacks were also more likely to have a history of obstructive pulmonary disease (OR: 2.73; 1.24-6.01), hypertension (OR: 2.78; 1.38-5.57), and multiple chronic conditions (3.04; 1.48-6.22).

Implications: Rural blacks were more likely to have risk factors for severe COVID-19 influencing their increased risk of hospitalization. These findings support that race as a risk factor for severe COVID-19 is compounded by rurality and identifies an important target group for vaccination.