Skip to Content

Arnold School of Public Health

  • Banner Image

Older adults comply with COVID-19 risk mitigation behaviors, but urban-rural disparities persist

July 22, 2021 | Erin Bluvas,

The lessons learned from the COVID-19 pandemic will continue to unfold for years to come. From economic impacts to viral transmission to psychosocial behaviors to long-term health effects, researchers across disciplines will study this once-in-a-century phenomenon from the micro to the global scale for decades.

One snapshot of this public health puzzle includes key takeaways from a study on risk mitigation behaviors (e.g., frequent handwashing, mask wearing, social distancing) among older adults during the summer of 2020. Researchers at the Rural and Minority Health Research Center found high levels of compliance among all older adults; however, rural residents were consistently less likely than their urban counterparts to adhere to these recommendations. As with many health disparities and barriers that plague rural communities, targeted strategies are needed during the vaccination stage and in preparation for future public health crises (including the spread of emerging COVID-19 variants) to lessen the impacts on these underserved populations.

Small disparities in risk mitigation efforts, coupled with differences in vaccination rates, may make a big difference in health and survival.

-Janice Probst, Distinguished Professor Emerita of Health Services Policy and Management and Deputy Emerita for the Rural and Minority Health Research Center

While many remember the rapid spread of SARS-CoV-2 in cities like New York and Seattle at the beginning of the pandemic, by late summer, both incidence and death rates for COVID-19 in rural communities began to exceed those in urban areas. An older population, higher poverty, more pre-existing health risks, lack of health insurance, and greater distance to healthcare services are all contributing factors to the higher mortality rates in rural communities.

With this study, the researchers analyzed data from a mail survey of nearly 3,000 participants in the National Health and Aging Trends Study to explore how personal behaviors may influence exposure risk for COVID-19. They were specifically interested in rural-urban differences in COVID-19 risk mitigation among community-dwelling (i.e., individuals not in assisted living, nursing homes, or other congregate settings) older adults (ages 65+) – a group that had already been identified as higher risk for death from COVID-19. 

“What we found is a mix of good news and bad news,” says Janice Probst, Distinguished Professor Emerita of Health Services Policy and Management and deputy emerita for the Rural and Minority Health Research Center. “The good news was that all older adults reached by the survey were likely to be following recommendations, but the bad news was that for five out of eight specific behaviors, rural older adults were just less likely than urban to be doing each one.”

Regardless of where they lived, 97.6 percent of older adults reported compliance with Centers for Disease Control and Prevention recommendations regarding frequent handwashing or sanitizing and wearing masks. Similarly, 87.4 percent of all adults reported limiting shopping and errands.

However, rural older adults were significantly less likely to report five other risk mitigation behaviors: maintaining six feet of distance, limiting gathering, avoiding restaurants/bars, avoiding face touching, and avoiding people not in their household. The authors caution that these disparities may increase vulnerability to infection among rural adults and have implications for their response to future outbreaks.

“Small disparities in risk mitigation efforts, coupled with differences in vaccination rates, may make a big difference in health and survival,” Probst says. “There needs to be a way to identify public health messaging best suited to rural populations, in preparation for future time-sensitive emergencies such as the COVID-19 variants.”


Researchers publish free workbook for students, faculty on health in rural America

Alumni, faculty investigate the negative impacts of the pandemic on academics who mother

UofSC Prevention Research Center leads state-wide project to increase COVID-19 vaccinations among underserved communities

Researchers find higher rates of mental health conditions among pregnant women during COVID-19 pandemic

Master of Health Administration alumnus leads efforts to bring vaccines to rural residents

Challenge the conventional. Create the exceptional. No Limits.