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Assessing the Impact of Area Deprivation Index on COVID-19 Prevalence: A Contrast Between Rural and Urban U.S. Jurisdictions

The COVID-19 pandemic has impacted communities differentially, with poorer and minority populations being more adversely affected. Prior rural health research suggests such disparities may be exacerbated during the pandemic and in remote parts of the U.S. To understand the spread and impact of COVID-19 across the U.S., county level data for confirmed cases of COVID-19 were examined by Area Deprivation Index (ADI) scores and Metropolitan vs. Nonmetropolitan designations from the National Center for Health Statistics (NCHS). These designations were the basis for making comparisons between Urban and Rural jurisdictions. Kendalls Tau-B was used to compare effect sizes between jurisdictions on select ADI composites and well researched social determinants of health (SDH). Spearman coefficients and a moderation analysis using Poisson modeling was used to explore the relationship between ADI and COVID-19 prevalence in the context of county designation. Results show that the relationship between area deprivation and COVID-19 prevalence was positive and higher for rural counties, when compared to urban ones and that family income and poverty had a stronger relationship with prevalence than other ADI component measures. Though most Americans live in Metropolitan Areas, rural communities were found to be associated with a stronger relationship between deprivation and COVID-19 prevalence. Models for predicting COVID-19 prevalence by ADI and county type reinforced this observation but revealed no moderating effect of county type on ADI.