Are Older Populations at a Disadvantage? County-Level Analysis of Confirmed COVID-19 Cases in Urban and Rural America

Objectives: This study examines how areas with different older population compositions are affected by Coronavirus Disease 2019 (COVID-19) and whether urban and rural counties face different challenges. Methods: Applying negative binomial regression to a data set of U.S. counties (N = 3,042), we estimated the relationship between older population ratios and the number of confirmed COVID-19 cases, and how this relationship changes over time in urban and rural counties, respectively. Results: Although low-ratio counties show the highest number of confirmed cases of COVID-19 at the beginning of the pandemic, confirmed cases in high-ratio counties (>25% of the total population is aged 65 and older) increase exponentially with time in urban areas. High-ratio rural counties hit their peak later and recover more slowly compared to low- and medium-ratio rural counties. Discussion: Both urban and rural counties with larger older populations are more vulnerable and their disadvantages in COVID-19 infections are more rapidly exacerbated over time in urban areas. This underscores the importance of early action in those counties for effective intervention and prevention.