Rural Ohio Faces High Health Risk during the COVID-19 Pandemic

Danielle Rhubart, Shannon M. Monnat and Yue Sun

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Ohio was one of the first states to implement interventions to reduce community spread during the first wave of the pandemic. As the state now experiences a new surge in cases, metro counties are home to some of the highest rates. However, the level of health and mortality risk posed by COVID-19 is highest in the most rural counties. Data from our Index of Severe Health Risk for Ohio Counties (Figure 1) show that 46% of Ohio’s small nonmetro counties face high COVID-19 mortality risk, compared to just 18% of metro and large nonmetro counties (Figure 2). Small nonmetro counties have larger shares of older adults and higher prevalence of several chronic health conditions that increase risk of severe complications or death should one contract COVID-19 (e.g. respiratory problems, diabetes, heart disease, high blood pressure, and obesity). In contrast, 43% of metro counties are categorized as having low COVID-19 health and mortality risk. Only 18% of large nonmetro counties and 8% of small nonmetro counties are in the low risk category. Leaders of several rural Ohio counties have pushed back against the state’s physical distancing mandates. Many of these counties are at risk of experiencing high rates of COVID-19 hospitalizations and deaths should there be an outbreak, so they should support strong actions to prevent community spread.

About the Authors
Danielle Rhubart ( is the Lerner Postdoctoral Fellow in the Lerner Center for Public Health Promotion in the Maxwell School at Syracuse University (SU). Shannon M. Monnat ( is the Lerner Center Director and Lerner Chair for Public Health Promotion, Associate Professor of Sociology, and Co-Director of the Policy, Place, and Population Health (P3H) Lab in the Maxwell School. Yue Sun ( is a PhD student in the Sociology Department, a Lerner Center Graduate Research Assistant, and a Graduate Affiliate of the P3H Lab.

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