Rural African Americans are at higher risk from covid-19

Though all population groups have been hit by the coronavirus pandemic, some are at a disproportionate risk of dying from covid-19 in the United States. That includes rural residents and racial/ethnic minorities. Those who are both, especially rural African-Americans, have a much higher risk of being hospitalized and/or dying from the infection, according to a newly published paper in The Journal of Rural Health.

That echoes other studies that have found rural non-whites' overall medical risk to be higher, compounded by their rural location, access and health issues spurred by historical racial inequalities, and unconscious bias from medical providers.

The paper examines three possible explanations for why African-Americans are at a greater risk for covid-19, including social determinants of health (where someone is born, what kind of family they're born in and grow up with, and other factors all influenced by the distribution of money, power and resources), comorbidities and coexposures (underlying health issues and risk factors such as smoking), and genetic differences.

The authors recommend "innovative preventive and therapeutic interventions targeting the rural African American communities" to help fight the spread of covid-19.

Catholic hospitals play bigger role in rural health care

Some hospitals on the 2011 map don't appear on the 2016 map either because they're no longer associated with a
Catholic institution or because they're no longer classified as the sole community hospital. (FiveThirtyEight map)

More and more, rural residents' access to some health care services may be determined by the doctrine of the Roman Catholic Church.

"In a growing number of communities around the country, especially in rural areas, patients and physicians have access to just one hospital. And in more and more places, that hospital is Catholic," Anna Maria Barry-Jester and Amelia Thomson-DeVeaux report for FiveThirtyEight. "That sounds innocuous — a hospital is a hospital, after all. But Catholic hospitals are bound by a range of restrictions on care that are determined by religious authorities, with very little input from medical staff. Increasingly, where a patient lives can determine whether Catholic doctrine, and how the local bishop interprets that doctrine, will decide what kind of care she can get."

Commonly affected services include abortion, birth control, some end-of-life care, and gender-affirmation procedures. Some doctors who had worked at Catholic hospitals told the reporters that they had been unable to give what they felt was the most effective treatment to some patients because of religious restrictions. Some low-income women are not able to go elsewhere for services not provided by Catholic hospitals, due to financial and transportation challenges.

Catholic hospitals have had some latitude to deny certain treatment options for decades, but that power has been expanded under recent moves by the Trump administration. President Trump signed an executive order saying his administration would protect religious freedom, then the Department of Health and Human Services ruled that large employers don't have to cover birth control for employees. HHS also created a Conscience and Religious Freedom Division to focus on protecting employers' rights.

Nationwide, "best estimates suggest that one in six hospital beds and many of the nation’s largest nonprofit health systems are Catholic-owned or -affiliated," Barry-Jester and Thomson-DeVeaux report. "From 2001 to 2016, the number of Catholic-affiliated hospitals in the U.S. grew by 22 percent, even as the total number of hospitals in the U.S. shrunk, according to research by MergerWatch and the American Civil Liberties Union. And the changes vary by region. In Washington state, more than 40 percent of hospital beds are in Catholic institutions. In several Midwestern states, more than 30 percent of beds are in Catholic hospitals.

This is partly because Catholic hospitals may be able to weather financial hardship better because of their nonprofit status, efficiency, and access to Catholic church funding.

Teen pregnancy declines more slowly in rural areas

The national teen pregnancy rate is lower than ever, but "The teen birth rate in rural counties is nearly one-third higher than the rest of the nation" and is declining more slowly than in metropolitan areas, USA Today reports, citing what is says is a "first-of-its-kind analysis by the National Campaign to Prevent Teen and Unplanned Pregnancy."

"The prevailing stereotype is that teen parenthood is primarily an urban and suburban phenomenon," Bill Albert, chief program officer for the Washington, D.C.-based non-profit, told reporter Michelle Healy. "The landscape of teen childbearing is more open spaces and fresh air than gridlock and high-rises." And that applies across all ethnic and racial groups, the data show.

Researchers used National Center for Health Statistics data for 2010, the most recent available (2011 figures are still being double-checked). From 1990 to 2010, the teen birth rate in rural counties dropped 32 percent, but that was much less than in major metro areas (49 percent) and suburbs (40 percent). The national rate dropped to 34 per 1,000 teenage girls from 60 per 1,000; the rural rate was 43 per 1,000.

The reasons? Availability of birth control in rural areas "lags far behind availability for teens living in urban and metro areas," said Julia De Clerque,​​ a research fellow and investigator at the University of North Carolina Sheps Center for Health Services Research. Also, "For many rural families, teen pregnancy and parenting are cultural norms, repeated generation after generation," said Josie Weiss, a nursing professor at Florida Atlantic University. (Read more)