Rural-Urban Variation in COVID-19 Experiences and Impacts among U.S. Working-Age Adults

• Author: Shannon M. Monnat
• Published date: 01 November 2021
• Date: 01 November 2021
• DOI: http://doi.org/10.1177/00027162211069717

ANNALS, AAPSS, 698, November 2021 111

DOI: 10.1177/00027162211069717

Rural-Urban

Variation in

COVID-19

Experiences

and Impacts

among U.S.

Working-Age

Adults

By

SHANNON M. MONNAT

1069717ANN The Annals of The American AcademyRural-Urban Variation in COVID-19

research-article2021

This study investigates rural-urban differences in

COVID-19 in terms of its impacts on the physical and

mental health, social relationships, employment, and

financial hardship of U.S. working-age adults (18–64). I

use data from the National Wellbeing Survey collected

in February and March 2021 (N = 3,933). Most

respondents (58 percent) reported that COVID-19 has

had a negative impact on their lives. Residents of rural

counties adjacent to metro areas reported the worst

outcomes: they were more likely than residents of large

urban counties to report positive tests for coronavirus;

to live with someone who tested positive or have a close

friend or family member outside of the household test

positive; to have a close friend or family member hospi-

talized; to seek treatment for anxiety or depression; to

be late paying rent, mortgage, and other bills; to not be

able to afford groceries or other necessities; and to get

a loan from family or friends. Recovery policies must

consider geographic variation in COVID-19 vulnerabil-

ity and impacts.

Keywords: COVID-19; rural; urban; health

In the early weeks of the spread of the

COVID-19 pandemic in the United States, I

suggested that COVID-19 could hit rural areas

harder than urban areas (Monnat 2020). I

argued that while lower population density may

protect rural areas from spread early on, both

the population composition (e.g., older, higher

chronic disease rate) and contextual features

(e.g., less health care availability, labor markets

not conducive to remote work) of rural com-

munities put them at risk of higher rates of

mortality from COVID-19 once the virus

spread to those places. I also suggested that the

Shannon M. Monnat is an associate professor of sociol-

ogy, Lerner Chair for Public Health Promotion, Lerner

Center director, and codirector of the Policy, Place, and

Population Health Lab at Syracuse University. Her

research looks at geographic differences in heath and

mortality, with a specific focus on rural health and

health disparities.

Correspondence: smmonnat@syr.edu

112 THE ANNALS OF THE AMERICAN ACADEMY

longer-term health and economic impacts could be worse in rural than in urban

areas due to their less-diversified labor markets. Since then, a growing body of

research has shown higher cumulative COVID-19 infection and mortality rates

in rural counties (Cromartie etal. 2020; Huang et al. 2021; Pender 2021; Sun,

Cheng, and Monnat 2021) but potentially less severe labor market impacts

(Brooks, Mueller, and Thiede 2021; Cho, Lee, and Winters 2020; Cromartie

etal. 2020). However, rural areas are not homogenous, and we have seen signifi-

cant variation in COVID-19 spread and mortality rates among rural communities

(Cheng, Sun, and Monnat 2020; Cohen 2020; Cromartie etal. 2020; Sun, Cheng,

and Monnat 2021).

The consequences of COVID-19 extend far beyond the deaths that it has

caused. The pandemic itself, and the spread mitigation policies that it prompted,

may have adversely affected physical and mental health (Brodeur et al 2021;

Czeisler, Lane, et al. 2020; Gassman-Pines, Ananat, and Fitz-Henley 2020;

Killgore etal. 2020; McPhee etal. 2020; Twenge and Joiner 2020), led to employ-

ment loss and financial hardship (Board of Governors of the Federal Reserve

System 2020; Congressional Research Service 2021; Horowitz, Brown, and

Minkin 2021), disrupted family and social relationships (Calbi etal. 2021; Kovacs

et al. 2021; Philpot et al. 2021), and disrupted health care access (Czeisler,

Marynak, etal. 2020). Existing research on the secondary impacts of the pan-

demic in the United States generally shows worse outcomes among non-Hispanic

Blacks, women, and individuals without a college degree (Collins etal. 2021; Dias

2021; Kesler and Bash 2021; Landivar etal. 2020; Montenovo etal. 2020; Perry,

Aronson, and Pescosolido 2020). In a sample of rural residents of the western

United States conducted in June 2020, Mueller etal. (2021) found significant

negative self-reported impacts of the pandemic on employment, overall life sat-

isfaction, mental health, and economic outlook, with half of rural western

respondents perceiving some level of negative impact on their lives. However, to

my knowledge, no research exists that examines rural-urban differences in

COVID-19 experiences and secondary outcomes for the United States overall.

More than forty-six million people live in rural America, including some the

country’s most economically and health-vulnerable populations (Cromartie etal.

2020). Identifying the geographically differential impacts of the COVID-19 pan-

demic on well-being is essential for informing recovery policies and prevention

strategies for future pandemics.

The lack of geographic identifiers and small nonmetro sample sizes in most

national surveys that have assessed COVID-19 impacts prohibit examination of

differences among rural communities. This article addresses this limitation by

NOTE: The author acknowledges support from two research networks funded by the National

Institute on Aging (R24AG065159 and 2R24AG045061); the NIA-funded Center for Aging

and Policy Studies at Syracuse University (P30AG066583); the NICHD-funded Population

Research Institute at Penn State (P2CHD041025); the USDA Agricultural Experiment Station

Multistate Research Project: W4001, Social, Economic and Environmental Causes and

Consequences of Demographic Change in Rural America; and the Syracuse University Lerner

Center for Public Health Promotion.