COVID-19 Hospitalization Trends in Rural Versus Urban Areas in the United States

Yi Zhu, Caitlin Carroll, Khoa Vu, Soumya Sen, Archelle Georgiou, Pinar Karaca Mandic

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Since the summer of 2020, the rate of coronavirus cases in the United States has been higher in rural areas than in urban areas, raising concerns that patients with coronavirus disease 2019 (COVID-19) will overwhelm under-resourced rural hospitals. Using data from the University of Minnesota COVID-19 Hospitalization Tracking Project and the U.S. Department of Health and Human Services, we document disparities in COVID-19 hospitalization rates between rural and urban areas. We show that rural-urban differences in COVID-19 admission rates were minimal in the summer of 2020 but began to diverge in fall 2020. Rural areas had statistically higher hospitalization rates from September 2020 through early 2021, after which rural-urban admission rates re-converged. The insights in this article are relevant to policymakers as they consider the adequacy of hospital resources across rural and urban areas during the COVID-19 pandemic.

Original languageEnglish (US)
Pages (from-to)236-244
Number of pages9
JournalMedical Care Research and Review
Issue number2
StatePublished - Apr 2023

Bibliographical note

Funding Information:
This research uses data from the University of Minnesota COVID-19 Hospitalization Project, which is partially funded by the University of Minnesota Office of Academic Clinical Affairs and the United Health Foundation. These organizations had no role in data collection or the conduct of this study and have not reviewed or approved the manuscript. Data used in this research are available by contacting the project team. This research also uses publicly available data on COVID-19 hospitalizations from the U.S. Department of Health and Human Services (HHS), which is downloadable from the HHS website. The University of Minnesota Institutional Review Board reviewed the study data and exempted it from review because it did not constitute human subject research.

Funding Information:
The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dr. Karaca-Mandic reports funding from the University of Minnesota, Office of Academic Clinical Affairs, and grants from United Health Foundation during this project. In the past 36 months, she also reports personal fees from Tactile Medical, personal fees from Precision Health Economics, personal fees from Sempre Health, grants from the Agency for Healthcare Research and Quality, grants from the American Cancer Society, grants from National Institute for Health Care Management, grants from National Institute on Drug Abuse, and grants from National Institutes of Health, all outside of the context of this manuscript. Dr. Karaca Mandic also serves in an executive position and holds equity in XanthosHealth LLC, which is developing a health information technology in oncology. These interests have been reviewed and managed by the University of Minnesota in accordance with its Conflict of Interest policies. Dr. Georgiou reports personal fees from HealthGrades outside the submitted work.

Publisher Copyright:
© The Author(s) 2022.


  • COVID-19
  • hospital resources
  • hospitalizations
  • rural and urban disparities
  • rural health


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