Fahs_Another+Mortality+Penalty+for+Rural+Populations+Final+2022


 
Online Journal of Rural Nursing and Health Care, 22(1) 
https://doi.org/10.14574/ojrnhc.v22i1.714 

 1 

Editoral 

Another Mortality Penalty for Rural Populations: Covid 19? 

Pamela Stewart Fahs, PhD, RN, Editor 

There is a gap in mortality between rural and urban people. This has been referred to as the 

rural mortality penalty (Alreshidai et al., 2020; James, 2014). There are more deaths in five major 

areas among rural than urban populations (Centers for Disease Control and Prevention [CDC], 

n.d.). Data are now emerging that indicate rural Americans are in the unenviable position of being 

more likely to have died from covid-19 than those in urban areas (Marema, 2022; Rural Health 

Information Hub, n.d.). Although covid was initially seen more frequently and was the cause of 

more deaths in urban than rural areas; by August 1, 2020 the mortality rates were equal. Rural 

mortalities became higher than urban in all but three reporting weeks thereafter (CDC embedded 

data in Marema, 2022). In this data, rural was defined using Office of Management and Budget, 

2013 criteria for counties outside of a metropolitan statistical area (as cited in Marema, 2022). The 

largest difference in rural/urban covid mortality, occurred December 2020; rural 8.29 vs. urban 

4.79, per 100,000 per week.  

Since February 2022, mortality rates have declined in rural and metropolitan areas. Starting 

the week of April 17, 2022, a divergence began and became wider on May 1, 2022, when urban 

mortality continued to decline while rural mortality began to climb again. More analysis will be 

needed to better understand why rural people are dying at a higher rate, at 100,000 per week than 

urban dwellers. Vaccinations rates are part of the problem; however, the classic disparities in rural 

and urban health care may well hold a role in this latest rural mortality penalty. Lack of access to 

health care, especially specialty care, issues of transportation that complicate accessing health care, 

and underinsured could be part of the problem. Additionally, rural populations tend to have higher 



 
Online Journal of Rural Nursing and Health Care, 22(1) 
https://doi.org/10.14574/ojrnhc.v22i1.714 

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risks that contribute to chronic illnesses (CDC, n.d.). Nurse scientists focused on rural health 

should delve into the problem of higher crude covid mortality rates among rural dwellers. Those 

rural nurses providing direct care in both acute and public settings need to redouble efforts toward 

vaccination and education on mitigating methods and treatments. Beyond these roles, work on 

reducing macro level disparities is one area that needs continued intra-professional attention, if we 

are ever going to reduce the rural mortality penalty. 

 
References 

Alreshidi, B. G., Kalman, M., Wells, M., & Fahs, P. S. (2020). Cardiovascular risk reduction in 

rural women: A literature Synthesis. Journal of Cardiovascular Nursing, 35(2). 199-209. 

https://doi.org/10.1097/jcn.0000000000000622  

Centers for Disease Control and Prevention (n.d.). About rural health. https://www.cdc.gov/ 

ruralhealth/about.html  

James, W. L. (2014). All rural places are not created equal: Revisiting the rural mortality penalty 

in the United States. American Journal of Public Health, 104(11). 2122-2129. 

https://doi.org/10.2105/ajph.2014.301989  

Marema, T. (2022, May 5). New covid infections climb 50% over past two weeks in rural 

communities. The Daily Yonder. https://dailyyonder.com/  

Rural Health Information Hub. (n.d.). News Headlines. https://www.ruralhealthinfo.org/