BQ Journal Vol 47 - Q2 2022 - 29

Morbidity and Mortality Weekly Report
Disparities in COVID-19 Vaccination Coverage Between Urban and Rural
Counties - United States, December 14, 2020-January 31, 2022
Ryan Saelee, PhD1,2; Elizabeth Zell, MStat1,2,3; Bhavini Patel Murthy, MD1,2; Patricia Castro-Roman, MPH2,4; Hannah Fast, MPH1,2;
Lu Meng, PhD2,5; Lauren Shaw, MS1,2; Lynn Gibbs-Scharf, MPH1,2; Terence Chorba, MD2,6; LaTreace Q. Harris, MPH1,2; Neil Murthy, MD1,2
Higher COVID-19 incidence and mortality rates in rural
than in urban areas are well documented (1). These disparities
persisted during the B.1.617.2 (Delta) and B.1.1.529
(Omicron) variant surges during late 2021 and early 2022
(1,2). Rural populations tend to be older (aged ≥65 years)
and uninsured and are more likely to have underlying medical
conditions and live farther from facilities that provide
tertiary medical care, placing them at higher risk for adverse
COVID-19 outcomes (2). To better understand COVID-19
vaccination disparities between urban and rural populations,
CDC analyzed county-level vaccine administration data
among persons aged ≥5 years who received their first dose of
either the BNT162b2 (Pfizer-BioNTech) or mRNA-1273
(Moderna) COVID-19 vaccine or a single dose of the Ad.26.
COV2.S (Janssen [Johnson & Johnson]) COVID-19 vaccine
during December 14, 2020-January 31, 2022, in 50 states
and the District of Columbia (DC). COVID-19 vaccination
coverage with ≥1 doses in rural areas (58.5%) was lower than
that in urban counties (75.4%) overall, with similar patterns
across age groups and sex. Coverage with ≥1 doses varied
among states: 46 states had higher coverage in urban than in
rural counties, one had higher coverage in rural than in urban
counties. Three states and DC had no rural counties; thus,
urban-rural differences could not be assessed. COVID-19
vaccine primary series completion was higher in urban than in
rural counties. However, receipt of booster or additional doses
among primary series recipients was similarly low between
urban and rural counties. Compared with estimates from a
previous study of vaccine coverage among adults aged ≥18 years
during December 14, 2020-April 10, 2021, these urban-rural
disparities among those now eligible for vaccination (aged
≥5 years) have increased more than twofold through January
2022, despite increased availability and access to COVID-19
vaccines. Addressing barriers to vaccination in rural areas
is critical to achieving vaccine equity, reducing disparities,
and decreasing COVID-19-related illness and death in the
United States (2).
Data on COVID-19 vaccine doses administered in the
United States are reported to CDC by jurisdictions, pharmacies,
and federal entities through immunization information
systems (IISs),* the Vaccine Administration Management
System (VAMS),† or through direct data submission.§ Persons
aged ≥5 years with a valid county of residence in one of the
50 states or DC who received their first dose of a COVID-19
vaccine¶ during December 14, 2020-January 31, 2022, and
whose deidentified data were reported to CDC were included
in the analysis.** Urban-rural comparisons could not be made
for three states (Delaware, New Jersey, and Rhode Island)
and DC because they only had urban counties. In addition,
eight counties in California with population size <20,000
were excluded because they have data-sharing restrictions on
county-level information reported to CDC. Vaccine doses
administered to persons residing in U.S. territories and freely
associated states were also excluded because jurisdictional
divisions could not be mapped to urban-rural classifications
at the county level.
Receipt of the first dose of COVID-19 vaccine was matched
by county of residence to one of six urban-rural categories
according to the 2013 National Center for Health Statistics
Urban-Rural Classification Scheme (3). To further classify
counties into two categories (urban versus rural), four of these
six categories (large central metropolitan, large fringe metropolitan,
medium metropolitan, and small metropolitan) were
combined into an urban category, and two (micropolitan and
noncore) were combined into a rural category (3).
Vaccination coverage for persons aged ≥5 years who received
≥1 doses of a 2-dose COVID-19 primary vaccination series or
a single dose of the Janssen COVID-19 vaccine was calculated
overall and by age group (5-11, 12-17, 18-64, and ≥65 years),
sex, jurisdiction, and urban-rural classification (two- and sixlevel).
Population size was obtained by county, age group, and
sex from the U.S. Census Bureau's 2020 Population Estimates
* IISs are confidential, computerized, population-based systems that collect and
consolidate vaccination data from providers in 64 public health jurisdictions
nationwide and can be used to track administered vaccines and measure
vaccination coverage. The 64 IIS jurisdictions comprise the 50 U.S. states,
five U.S. territories (American Samoa, Guam, Northern Mariana Islands,
Puerto Rico, and U.S. Virgin Islands), three freely associated states (Federated
States of Micronesia, Marshall Islands, and Palau), and six local jurisdictions
(Chicago, Illinois; Houston, Texas; New York, New York; Philadelphia,
Pennsylvania; San Antonio, Texas; and Washington, DC).
† https://www.cdc.gov/vaccines/covid-19/reporting/vams/program-information.html
§ https://www.cdc.gov/vaccines/covid-19/reporting/overview/IT-systems.html
¶ Includes the first dose of a 2-dose vaccination series (Pfizer-BioNTech or
Moderna) as well as a single dose of the Janssen vaccine.
** Providers are required to document vaccination in their medical records within
24 hours of administration and in their jurisdiction's IISs within 72 hours of
administration. A total of 5 days of observation were included to account for
any delays in reporting and transmission of records to CDC.
US Department of Health and Human Services/Centers for Disease Control and Prevention
MMWR / March 4, 2022 / Vol. 71 / No. 9
335
Diagnostics I Pharmaceuticals I DxRx Solutions I Continuing Education I News
29
A Henry Schein Publication

https://www.cdc.gov/vaccines/covid-19/reporting/vams/program-information.html https://www.cdc.gov/vaccines/covid-19/reporting/overview/IT-systems.html

BQ Journal Vol 47 - Q2 2022

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