Rural Americans die of cancer at more than double the rate of their urban counterparts. This disparity, health experts say, will widen as medical care becomes more limited for an aging, sicker, fatter, poorer, and less vaccinated population.
While the initial wave of covid-19 deaths mostly avoided rural America, where around 15% of Americans live, nonmetropolitan mortality rates quickly began to outstrip metropolitan areas before immunizations became available, according to data from the RPRI (Rural Policy Research Institute).
According to the institute’s research, since the pandemic, 1 in 434 rural Americans has died from covid, compared to 1 in 513 urban Americans. Even though vaccines have reduced overall covid death rates since the winter peak, rural mortality rates are more than twice as elevated as urban rates – and are swiftly growing.
In rural northeastern Texas, Terry Scoggin, CEO of Titus Regional Medical Center, is coping with a townwide immunization rate of 39 percent. Eleven patients died of covid at his Mount Pleasant hospital in the first half of September, affecting 16,000 people. Three to four non-hospice patients die there per month on average.
“We don’t see death that way,” Scoggin continued. “It’s not every day that you get to see your friends and neighbors pass away.”
Covid incidence rates were roughly 54 percent higher in rural areas in September than elsewhere, according to Fred Ullrich, a research analyst at the University of Iowa College of Public Health who co-authored the institute’s article. Rates in nonmetropolitan or rural areas were compared to rates in metropolitan or urban areas in the study. He went on to say that in 39 states, rural counties have a higher incidence of covid than urban counties.
According to Alan Morgan, president of the National Rural Health Association, “there is a national difference between perception and reality for covid in rural America.” “We’ve made a lot of rural places murder hotspots.” There is no public or political movement to combat what we see in many areas.”
Even still, the high incidence of illnesses and low vaccination rates do not explain why rural death rates are so much higher than elsewhere. Rural Americans’ poor health and limited medical care options are seen as a deadly combination by academics and government authorities. The pandemic’s stress has compounded the problem by increasing hospital staffing shortages, resulting in a vicious cycle limiting care availability.
Vaccines are the most effective tool in the fight against deadly covid infections. According to The Daily Yonder, a rural newsroom, as of September 23, roughly 41% of rural America had been vaccinated, compared to around 53% of urban America. Due to a shortage of resources and access, shots were first difficult to come by in rural locations. Despite this, governments and researchers attribute low immunization rates to vaccine aversion, misinformation, and politics.
As of Sept. 27, 26% of Newton County residents in hard-hit southern Missouri had received all of their vaccinations. According to department head Larry Bergner, the health department has sponsored raffles, vaccine clinics, marketing, and even driven the vaccine to those without transportation in distant areas. He believes, however, that when a person’s social group dies or gets gravely ill, interest in the shots frequently develops.
Furthermore, overcrowding of covid patients in hospitals has eroded a key pillar of rural health care infrastructure: the ability to transfer patients from rural hospitals to higher levels of specialty treatment at regional or urban health institutions.
“We’ve had email database of rural chief nursing officers or rural CEOs sending up an SOS to the group, saying, ‘We’ve called over 70 hospitals and can’t get this heart attack, stroke, or surgical patient out, and will likely get septic and die if it goes on much longer,'” said John Henderson, CEO of the Texas Organization of Rural & Community Hospitals.
Morgan claims he’s lost count of the number of people who have asked him about the switch.
“It’s ludicrous, ludicrous, ludicrous.” Morgan stated, “It’s inexcusable.” “The mortality gap is widening, as far as I can determine.”
With 181 rural hospitals disappearing since 2005, medical care has long been a challenge in rural America. According to a study, more than half of all counties in the United States lack a critical care unit, with many of them being largely rural.
Before the epidemic, rural Americans had a 20% higher total death rate than urban Americans, according to information from the Centers for Disease Control and Prevention’s National Center for Health Statistics. This is due to factors, including lower insurance rates, higher poverty rates, and more restricted access to health care.
In 2018, Ripley County, Missouri’s municipal hospital closed its doors. As of September, only 24% of residents had received the required covid vaccination. According to Tammy Cosgrove, the health department’s director, Covid patients are being discharged from emergency rooms in neighboring counties due to a recent rise in instances.
The country’s nurse shortage is especially acute in remote areas, where residents lack the financial means to pay the exorbitant rates requested by travel nursing companies. Many rural nurses leave their current positions because nursing temp agencies offer them better pay to join their teams. Scoggin’s nurse suggested that he take a travel job because she could pay off her debt in three months with that much money.
Then there’s the tiredness from working for over a year and a half to contain the outbreak. Audrey Snyder, immediate past president of the Rural Nurse Organization, said she had lost track of how many nurses had informed her that they were leaving. These resignations feed a never-ending cycle: as travel nurse companies hire more nurses, the nurses who are left behind become increasingly tired – and eventually depart. While this is true in all hospitals, the repercussions can be especially severe in rural hospitals with limited staffing.
Rural health officials are concerned that President Joe Biden’s proposed healthcare vaccine requirements could exacerbate the shortages, resulting in a wave of resignations that hospitals cannot absorb. Scoggin’s team, for example, is half-vaccinated.
Nursing shortages and the high costs associated with them will become unsustainable for rural hospitals that are already operating on razor-thin profit margins, according to Snyder. A fresh round of rural hospital closures, she predicted, will compound the dismal mortality statistics.
Due to personnel shortages, hospitals, according to Scoggin, are already constrained in the number of beds they may use. According to him, most Texas hospitals, including his own, are around two-thirds full. He also had to send a few patients home to be assessed by an ambulance team every day because his emergency department was overburdened.