Rural Covid-19 death, infection rates lower than urban rates for first time in 2-plus years

Published 7:44 am Tuesday, January 17, 2023

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Both Covid-19 infection and death rates last week were lower in rural counties than in metropolitan areas for the first time since the opening months of the pandemic, according to a Daily Yonder analysis.

The weekly rural death rate was about 12% lower than the metropolitan death rate last week.

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That’s only the eighth week since August 2020 that the rural death rate has been lower than the metro rate. In all of 2021, the rural death rate was lower for five separate weeks. In 2022, it was lower on just three occasions.

The relationship between rural and metropolitan infection rates has been less fixed. The early days of the pandemic saw urban areas with very high rates compared to rural areas because the epicenter of infections was the New York metropolitan area. Since those early months, new outbreaks generally led initially to higher metropolitan rates which later rolled into higher rates for rural areas.


Rural cases totaled 43,499 last week, 27% fewer infections than the previous week. The rural infection rate was 94.4 infections per 100,000 residents, 16,184 fewer infections than the previous week.

There were 342,545 new cases last week in metropolitan counties, where the infection rate was 121.4 cases per 100,000 residents. Urban infections dropped by 22%, 97,283 fewer infections than the previous week.

Nine of the 11 counties with a case rate of more than 500 per 100,000 residents were in Texas and Oklahoma. Daniels County, Montana, had a rate of 592 cases per 100,000, while San Juan County, Colorado, had a rate of 549. All of the counties with case rates higher than 500 were rural.

The infection data is from the Centers for Disease Control and Prevention. Actual infection rates are likely much higher because the CDC does not report infections detected through home testing. Also, Alabama, which has about 1 million rural residents, did not report data last week.


Rural America reported 0.66 deaths per 100,000 and 306 deaths last week, 134 fewer deaths than the previous week. The death rate dropped by 30%.

Urban areas reported 2,127 deaths last week, 13% fewer deaths than the 2,443 reported the previous week. The urban death rate was 0.75 deaths per 100,000.

At the beginning of the pandemic, when New York City was the epicenter of infections, urban death rates exceeded rural rates by 40-50% some weeks.

During the week of August 8, 2020, the rural death rate exceeded the urban rate for the first time since the beginning of the pandemic and it remained that way for all but a handful of weeks.

The cumulative death rate in rural America was 37% higher than the urban rate last week. The rural rate was 412.07 deaths per 100,000 and the urban rate was 301.29 deaths per 100,000 residents.