This policy brief examines differences in COVID-19 mortality rates across rural-urban designations and stratifications by geography, county-level sociodemographic factors, and county-level healthcare factors. Between December 2020 and January 2021, COVID-19 deaths were at their peak, hospital capacity was stretched, and COVID-19 vaccines were not widely available, making this a critical time period to examine.

Key Findings:

• COVID-19 mortality rates between December 2020 and January 2021 were highest in noncore counties, followed by micropolitan and metropolitan counties.
• The Midwest experienced the highest COVID-19 mortality rates, particularly in noncore counties.
• Compared to more racially and ethnically homogeneous counties, those with at least 20 percent of the population being Hispanic or American Indian/Alaska Native (AI/AN) had higher COVID-19 mortality rates. Micropolitan counties with at least 20 percent AI/AN population reported the highest rates.
• Counties with the highest nursing home bed density (by quartile) reported the highest mortality rates, regardless of rurality. Across all nursing home bed density quartiles, micropolitan and noncore counties had the highest mortality rate.

These findings may provide insights to ensure that the healthcare and social support system can manage the ongoing COVID-19 pandemic and prepare for future health emergencies.