The impact of COVID-19 on rural population: A retrospective study

Abstract

Objective: The COVID-19 outbreak became a major global health concern. There are some differences between urban and rural areas that may determine the impact of a viral pandemic. In our study, we aimed to investigate and present epidemiological, demographic, clinical, and radiological data relating to a rural area. Materials and Methods: This retrospective two-center study involved 2234 patients tested for COVID-19 between March 30th and July 15th, 2020. All patients were analysed for clinical, demographic, and radiological data. Results: Of the patients; 1309 (58.6%) were male, 925 (41.4%) female and 259 (11%) were PCR positive, and 1975 (89%) PCR negative. Of the PCR positive group, 121 (46.7%) were male and 138 (53.3%) female. The mean age was 38 ±18.5. Twenty-nine (11.2%) patients needed intensive care support. Twelve (4.6%) patients died due to COVID-19: two of them due to COVID-19-related myocardial infarction and ten of them due to severe pneumonia, acute respiratory distress syndrome (ARDS), multiorgan dysfunction, or septic shock. The case fatality rate (CFR) was 4.6%. Conclusion: Age, sex, hypertension, diabetes, asthma, and heart failure were associated with COVID-19 infection. The risk of infection was higher in patients older than 20 years (p<0.001) and females (OR: 1.636; p<0.001). Patients with hypertension (OR: 2.281; p<0.001), diabetes (OR: 1.013; p=0.039), asthma (OR: 2.786; p=0.001) or heart failure (OR: 2.610; p=0.006) had a significantly higher risk of infection.

Keywords

• COVID-19
• Viral pandemic
• Rural area

References

1. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. lancet 2020; 395: 497-506.
2. Chan JF-W, Yuan S, Kok K-H, et al. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster. Lancet 2020; 395: 514-23.
3. Wang C, Horby PW, Hayden FG, Gao GF. A novel coronavirus outbreak of global health concern. Lancet 2020; 395: 470-3.
4. Li Q, Guan X, Wu P, et al. Early transmission dynamics in Wuhan, China, of novel coronavirus–infected pneumonia. N Engl J Med 2020.
5. Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 2020; 395: 507-13.
6. Wei X, Xiao Y-T, Wang J, et al. Sex differences in severity and mortality among patients with COVID-19: evidence from pooled literature analysis and insights from integrated bioinformatic analysis. arXiv 200313547. 2020.
7. Zheng Z, Peng F, Xu B, et al. Risk factors of critical & mortal COVID-19 cases: A systematic literature review and meta-analysis. J Infect 2020; 81: e16-e25.
8. Sohrabi C, Alsafi Z, O’Neill N, et al. World Health Organization declares global emergency: A review of the 2019 novel coronavirus (COVID-19). Int J Surg 2020; 76: 71-6.

9. Jeyanathan M, Afkhami S, Smaill F, Miller MS, Lichty BD, Xing Z. Immunological considerations for COVID-19 vaccine strategies. Nat Rev Immunol 2020; 20: 615-32.
10. Garcia-Perez MA, Nunez-Anton V. Cellwise residual analysis in two-way contingency tables. Educ Psychol Meas 2003; 63: 825-39.
11. Cucinotta D, Vanelli M. WHO declares COVID-19 a pandemic. Acta Biomed Ateneo Parmense 2020; 91: 157-60.
12. Fehr AR, Perlman S. Coronaviruses: an overview of their replication and pathogenesis. Coronaviruses: Springer; 2015. p. 1-23.
13. Cosby AG, McDoom-Echebiri MM, James W, Khandekar H, Brown W, Hanna HL. Growth and persistence of place-based mortality in the United States: the rural mortality penalty. Am J Public Health 2019; 109: 155-62.
14. Kirakli C, Tatar D, Cimen P, et al. Survival from severe pandemic H1N1 in urban and rural Turkey: a case series. Respir care 2011; 56: 790-5.
15. Sharma G, Volgman AS, Michos ED. Sex differences in mortality from COVID-19 pandemic: are men vulnerable and women protected?. JACC Case Rep 2020; 2: 1407-10.
16. Fang L, Karakiulakis G, Roth M. Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection? Lancet Resp Med 2020; 8: e21.
17. Johnston SL. Asthma and COVID-19: Is asthma a risk factor for severe outcomes?. Allergy 2020; 75: 1543-5.
18. Mehra MR, Ruschitzka F. COVID-19 Illness and Heart Failure: A Missing Link?. JACC Heart Fail 2020; 8: 512-4.
19. Alqahtani JS, Oyelade T, Aldhahir AM, et al. Prevalence, severity and mortality associated with COPD and smoking in patients with COVID-19: a rapid systematic review and meta-analysis. PLoS one. 2020; 15: e0233147.
20. Moghadas SM, Fitzpatrick MC, Sah P, et al. The implications of silent transmission for the control of COVID-19 outbreaks. Proc Natl Acad Sci 2020; 117: 17513-5.
21. Bernheim A, Mei X, Huang M, et al. Chest CT findings in coronavirus disease-19 (COVID-19): relationship to duration of infection. Radiology 2020: 200463.
22. Rodriguez-Leor O, Cid-Alvarez B. ST-Segment Elevation Myocardial Infarction Care During COVID-19: Losing Sight of the Forest for the Trees. JACC Case Rep 2020; 2: 1625-7.
23. Khafaie MA, Rahim F. Cross-country comparison of case fatality rates of COVID-19/SARS-COV-2. Osong Public Health Res Perspect 2020; 11: 74.
24. Öztoprak F, Javed A. Case fatality rate estimation of COVID-19 for European countries: Turkey’s current scenario amidst a global pandemic; comparison of outbreaks with European countries. EJMO 2020; 4: 149-59