Date of Conferral

5-8-2025

Date of Award

May 2025

Degree

Ph.D.

School

Nursing

Advisor

Donna Bailey

Abstract

In the United States, the combination of a highly transmissible virus and the preexisting vulnerability of rural areas amplifies the impact of COVID-19 surges in the rural population compared to the urban counterpart. This quantitative non-experimental ex-post facto study aimed to determine whether there is a relationship between metro and non-metro locations and COVID-19 infection and mortality, and how age and employment status influence the outcomes. The theoretical framework was the rural nursing theory, with the social determinants of health providing the framework for integrating the underlying concept through the five domains of economic stability, education, health and health care, neighborhood and built environment, and social and community. This study found that rurality significantly influenced COVID-19 outcomes, with median age positively associated with infection rates in nonmetro areas but not metro areas. Study conclusions indicate that structural inequities and underfunding in rural communities contributed to health disparities in COVID-19. This study recommends incorporating additional demographic data and using tools like the Social Vulnerability Index in future studies to understand and address rural health challenges. Results of this study may promote positive social change by improving patient outcomes and mitigating transmission and deaths in the future, as the impact of rurality in emerging novel virus outbreaks is understood.

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