Disparities in COVID-19 Vaccination Coverage Between Urban and Rural Counties — United States, December 14, 2020–April 10, 2021
Open accessAbstract
Approximately 60 million persons in the United States live in rural counties, representing almost one fifth (19.3%) of the population.* In September 2020, COVID-19 incidence (cases per 100,000 population) in rural counties surpassed that in urban counties (1). Rural communities often have a higher proportion of residents who lack health insurance, live with comorbidities or disabilities, are aged ≥65 years, and have limited access to health care facilities with intensive care capabilities, which places these residents at increased risk for COVID-19-associated morbidity and mortality (2,3). To better understand COVID-19 vaccination disparities across the urban-rural continuum, CDC analyzed county-level vaccine administration data among adults aged ≥18 years who received their first dose of either the Pfizer-BioNTech or Moderna COVID-19 vaccine, or a single dose of the Janssen COVID-19 vaccine (Johnson & Johnson) during December 14, 2020-April 10, 2021 in 50 U.S. jurisdictions (49 states and the District of Columbia [DC]). Adult COVID-19 vaccination coverage was lower in rural counties (38.9%) than in urban counties (45.7%) overall and among adults aged 18-64 years (29.1% rural, 37.7% urban), those aged ≥65 years (67.6% rural, 76.1% urban), women (41.7% rural, 48.4% urban), and men (35.3% rural, 41.9% urban). Vaccination coverage varied among jurisdictions: 36 jurisdictions had higher coverage in urban counties, five had higher coverage in rural counties, and five had similar coverage (i.e., within 1%) in urban and rural counties; in four jurisdictions with no rural counties, the urban-rural comparison could not be assessed. A larger proportion of persons in the most rural counties (14.6%) traveled for vaccination to nonadjacent counties (i.e., farther from their county of residence) compared with persons in the most urban counties (10.3%). As availability of COVID-19 vaccines expands, public 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 (2).
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Rurality correlates with vaccine status and home internet access.
“Rurality may also contribute to the errors, because it correlates with vaccine status 8 and home internet access 40 .”
From Unrepresentative big surveys significantly overestimated US vaccine uptake (2021) · cites this paper as [8]
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Henning‐Smith, C., Dill, J., Baldomero, A. K., & Kozhimannil, K. B. (2022) · The Journal of Rural Health · doi:10.1111/jrh.12703 · Cited by 11 · see citing works
The Potential Impact of COVID-19 on the Asian Rural Economy: A Study Based on Asian Countries
Tiwari, S. P. (2022) · Journal of Education Management and Development Studies · doi:10.52631/jemds.v2i3.116 · Cited by 11 · see citing works
The influence of place on COVID-19 vaccine coverage in Alberta: A multilevel analysis
Paudel, Y. R., Du, C., & MacDonald, S. E. (2022) · PLoS ONE · doi:10.1371/journal.pone.0276160 · Cited by 11 · see citing works
Davis, T. C., Vanchiere, J. A., Sewell, M. R., Davis, A. B., Wolf, M. S., & Arnold, C. L. (2022) · Journal of Primary Care & Community Health · doi:10.1177/21501319221136361 · Cited by 11 · see citing works
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Influenza Vaccination During COVID-19 in a Rural Community: A Cross-sectional Survey
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Rapid-cycle designs to adapt interventions for COVID-19 in safety-net healthcare systems
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Addressing COVID-19 Vaccine Hesitancy in Patients with IBD
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COVID-19 Vaccine intent in appalachian patients with multiple sclerosis
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The response to the COVID-19 pandemic: With hindsight what lessons can we learn?
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- Authors
- Murthy, B. P., Sterrett, N., Weller, D., Zell, E., Reynolds, L., Toblin, R. L., Murthy, N., Kriss, J., Rose, C., Cadwell, B., Wang, A., Ritchey, M. D., Gibbs-Scharf, L., Qualters, J. R., Shaw, L., Brookmeyer, K. A., Clayton, H., Eke, P., Adams, L., Zajac, J., Patel, A., Fox, K., Williams, C., Stokley, S., Flores, S., Barbour, K. E., & Harris, L. Q.
- Affiliations
- National Center for Immunization and Respiratory Diseases (US)
- Corresponding author
- Murthy, Bhavini Patel
- ORCID
- Venue
- MMWR. Morbidity and Mortality Weekly Report
- Published
- 2021-05-21
- Volume
- 70
- Issue
- 20
- Pages
- 759-764
- ISSN
- 0149-2195 (ISSN-L)
- 1545-861X
- PMC
- PMC8136424
- OpenAlex
- W3160434659
- Cited by
- 230
- References
- 5
- Citations by year
- 2026: 13 · 2025: 27 · 2024: 21 · 2023: 59 · 2022: 77 · 2021: 33
- FWCI
- 26.24
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Locations
- MMWR Morbidity and Mortality Weekly Report (publishedVersion)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Funders
- U.S. Department of Defense
- Centers for Disease Control and Prevention
- Topics
- Social Sciences › Health › Vaccine Coverage and Hesitancy
- Health Sciences › Medicine › Infectious Diseases › SARS-CoV-2 and COVID-19 Research
- Physical Sciences › Mathematics › Modeling and Simulation › COVID-19 epidemiological studies
- Keywords
- COVID-19 vaccination coverage, urban-rural disparities, rural counties, vaccine hesitancy, vaccine access, BNT162b2, Moderna vaccine, Janssen vaccine, health disparities, older adults, COVID-19 pandemic
- MeSH terms
- Vaccination Coverage, COVID-19, COVID-19 Vaccines, Adolescent, Adult, Aged, Female, Humans, Male, Middle Aged, Rural Population, United States, Urban Population, Healthcare Disparities, Young Adult
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