Cross‐sectional population‐based estimates of a rural‐urban disparity in prevalence of long COVID among Michigan adults with polymerase chain reaction‐confirmed COVID‐19, 2020‐2022

• Published in: The Journal of rural health 2024-03, Vol.40 (2), p.303-313
• Main Authors: MacCallum‐Bridges, Colleen L., Hirschtick, Jana L., Allgood, Kristi L., Ryu, Soomin, Orellana, Robert C., Fleischer, Nancy L.
• Format: Article
• Language: English
• Subjects: Adult; Adults; Chemical analysis; Clinical outcomes; Commuting; COVID-19; COVID-19 - epidemiology; COVID-19 Testing; COVID-19 Vaccines; Cross-Sectional Studies; Estimates; Ethnicity; Health care access; health disparities; Health status; Humans; Illnesses; Immunization; Long COVID; Michigan - epidemiology; Pandemics; Polymerase Chain Reaction; Population studies; Post-Acute COVID-19 Syndrome; post‐COVID‐19 condition; Prevalence; Public relations; Race; Respondents; Risk factors; Risk reduction; Rural areas; Rural communities; rural health; Rural urban differences; Rurality; SARS-CoV-2; Severe acute respiratory syndrome coronavirus 2; Socioeconomic status; Socioeconomics; Statistical analysis; Surveillance; urban health; Urban Population; Vaccines; Viral diseases
• ISSN: 0890-765X; 1748-0361
• DOI: 10.1111/jrh.12807

Purpose To (1) assess whether residential rurality/urbanicity was associated with the prevalence of 30‐ or 90‐day long COVID, and (2) evaluate whether differences in long COVID risk factors might explain this potential disparity. Methods We used data from the Michigan COVID‐19 Recovery Surveillance Study, a population‐based probability sample of adults with COVID‐19 (n = 4,937). We measured residential rurality/urbanicity using dichotomized Rural‐Urban Commuting Area codes (metropolitan, nonmetropolitan). We considered outcomes of 30‐day long COVID (illness duration ≥30 days) and 90‐day long COVID (illness duration ≥90 days). Using Poisson regression, we estimated unadjusted prevalence ratios (PRs) to compare 30‐ and 90‐day long COVID between metropolitan and nonmetropolitan respondents. Then, we adjusted our model to account for differences between groups in long COVID risk factors (age, sex, acute COVID‐19 severity, vaccination status, race and ethnicity, socioeconomic status, health care access, SARS‐CoV‐2 variant, and pre‐existing conditions). We estimated associations for the full study period (Jan 1, 2020‐May 31, 2022), the pre‐vaccine era (before April 5, 2021), and the vaccine era (after April 5, 2021). Findings Compared to metropolitan adults, the prevalence of 30‐day long COVID was 15% higher (PR = 1.15 [95% CI: 1.03, 1.29]), and the prevalence of 90‐day long COVID was 27% higher (PR = 1.27 [95% CI: 1.09, 1.49]) among nonmetropolitan adults. Adjusting for long COVID risk factors did not reduce disparity estimates in the pre‐vaccine era but halved estimates in the vaccine era. Conclusions Our findings provide evidence of a rural‐urban disparity in long COVID and suggest that the factors contributing to this disparity changed over time as the sociopolitical context of the pandemic evolved and COVID‐19 vaccines were introduced.