Study finds disparities in health care coverage, hampered COVID-19 vaccination efforts in rural areas

Vaccine hesitancy is just one reason why fewer people in some parts of the United States have been inoculated against the coronavirus.

A study in the journal Lancet Regional Health found that wide disparities in health care coverage, particularly in rural areas, hampered vaccination efforts during the COVID-19 pandemic. The findings point to a hidden divide in America between those with ready geographic and financial access to doctors, hospitals and clinics and those without.

University of Cincinnati epidemiologist Diego Cuadros led an international team of researchers investigating disparities in vaccination rates in 2,417 US counties. They found that the availability of health care resources affects vaccine coverage.

The pandemic has killed more than 6.3 million people worldwide, including more than 1 million people in the United States alone. When it comes to the country’s relatively high death rate, researchers point to vaccination failures compared to other countries.

Cuadros, an associate professor of geography in UC’s College of Arts and Sciences, said vaccination rates vary widely across the United States. While some people may be reluctant to get vaccinated because of unfounded fear or misinformation, that only tells part of the story, he said.

During the pandemic, we realized the huge health care disparity we have in this country.”

Diego Cuadros, Associate Professor of Geography, UC College of Arts and Sciences

Barriers to accessing health care include cost, insurance coverage, and transportation.

In national surveys, about 20% of the US population has reported an unwillingness to be vaccinated. This does not account for the larger unvaccinated population. While more than half the population in every US state is now fully vaccinated, some states are far ahead of others.

Cuadros said areas with low vaccination rates saw the highest death rates from the virus during the delta and omicron waves, demonstrating the dire impact that health disparities can have on underserved communities.

Co-author Neil MacKinnon, a professor at Augusta University in Georgia, said the pandemic caused major disruptions in health care services even in countries with ready access. People visited their doctors much less often, leading to more undiagnosed cases of cancer and other diseases.

“Our study shows that these disruptions were not uniform across the United States,” MacKinnon said. “Many counties, particularly those in rural areas, experienced significant disruptions in health care, including the distribution of the COVID-19 vaccine itself.”

The new analysis found that people in underserved communities were up to 34% less likely to be vaccinated against COVID-19. These included counties in Nevada, Montana, North Dakota, South Dakota and Nebraska where vaccination rates were lower.

“America’s health care system has improvements that need to be made to address historical disparities that, as shown in our study, can affect decision-making at the individual level,” said study co-author and UC geography graduate student Santiago Escobar. “Our study suggests clear disparities that need to be addressed.”

Co-author Phillip Coule, MD, chief medical officer for Augusta University Health in Georgia, said the study underscores the impact of vaccination in fighting diseases like COVID-19.

“Those responsible for guiding health policy must consider issues such as vaccination rates, access to care and health disparities when assessing outcomes from COVID-19 and other conditions,” he said.