{"id":"https://openalex.org/W7222129397","doi":"https://doi.org/10.1177/21501319261498009","title":"Rurality as a Risk Factor for Excess Mortality in Nebraska During the COVID-19 Pandemic","display_name":"Rurality as a Risk Factor for Excess Mortality in Nebraska During the COVID-19 Pandemic","publication_year":2026,"publication_date":"2026-10-01","ids":{"openalex":"https://openalex.org/W7222129397","doi":"https://doi.org/10.1177/21501319261498009","pmid":"https://pubmed.ncbi.nlm.nih.gov/42880764"},"language":"en","primary_location":{"id":"doi:10.1177/21501319261498009","doi":"https://doi.org/10.1177/21501319261498009","is_oa":true,"landing_page_url":"https://doi.org/10.1177/21501319261498009","pdf_url":null,"source":{"id":"https://openalex.org/S59821943","display_name":"Journal of Primary Care & Community Health","issn_l":"2150-1319","issn":["2150-1319","2150-1327"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["cwts-core","doaj","jufo-1","ki-jl-1","medline","norway-1","poland-40","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310320017","host_organization_name":"SAGE Publishing","host_organization_lineage":["https://openalex.org/P4310320017"],"host_organization_lineage_names":["SAGE Publishing"],"type":"journal"},"license":"cc-by-nc","license_id":"https://openalex.org/licenses/cc-by-nc","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Journal of Primary Care & Community Health","raw_type":"journal-article"},"volume":null,"type":"article","is_traditional":true,"indexed_in":["crossref","doaj","pubmed"],"open_access":{"is_oa":true,"oa_status":"gold","oa_url":"https://doi.org/10.1177/21501319261498009","any_repository_has_fulltext":false},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5120666705","display_name":"ELENA EINSPAHR","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I1307117695","display_name":"Nebraska Medical Center","ror":"https://ror.org/03azxga02","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I1307117695"]},{"id":"https://openalex.org/I59130452","display_name":"University of Nebraska Medical Center","ror":"https://ror.org/00thqtb16","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I59130452"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Elena Einspahr","raw_affiliation_strings":["Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, USA"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, USA","institution_ids":["https://openalex.org/I1307117695","https://openalex.org/I59130452"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5012698004","display_name":"Yi Du","orcid":"https://orcid.org/0000-0003-4044-1989","observed_orcids":["https://orcid.org/0000-0003-4044-1989"]},"institutions":[{"id":"https://openalex.org/I1321340555","display_name":"Nebraska Department of Health and Human Services","ror":"https://ror.org/03m7azy07","country_code":"US","type":"government","lineage":["https://openalex.org/I1321340555"]},{"id":"https://openalex.org/I59130452","display_name":"University of Nebraska Medical Center","ror":"https://ror.org/00thqtb16","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I59130452"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Yi Du","raw_affiliation_strings":["Division of Public Health, Nebraska Department of Health and Human Services","University of Nebraska Medical Center, Lincoln, USA"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Division of Public Health, Nebraska Department of Health and Human Services","institution_ids":["https://openalex.org/I1321340555"]},{"raw_affiliation_string":"University of Nebraska Medical Center, Lincoln, USA","institution_ids":["https://openalex.org/I59130452"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5103067271","display_name":"James V. Lawler","orcid":"https://orcid.org/0000-0003-3736-8485","observed_orcids":["https://orcid.org/0000-0003-3736-8485"]},"institutions":[{"id":"https://openalex.org/I1307117695","display_name":"Nebraska Medical Center","ror":"https://ror.org/03azxga02","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I1307117695"]},{"id":"https://openalex.org/I59130452","display_name":"University of Nebraska Medical Center","ror":"https://ror.org/00thqtb16","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I59130452"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"James Lawler","raw_affiliation_strings":["Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, USA"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, USA","institution_ids":["https://openalex.org/I1307117695","https://openalex.org/I59130452"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5076464033","display_name":"Matthew A. Donahue","orcid":"https://orcid.org/0000-0001-5992-3422","observed_orcids":["https://orcid.org/0000-0001-5992-3422"]},"institutions":[{"id":"https://openalex.org/I2800466922","display_name":"Iowa Department of Human Services","ror":"https://ror.org/0077tm911","country_code":"US","type":"government","lineage":["https://openalex.org/I2800466922"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Matthew Donahue","raw_affiliation_strings":["Iowa Department of Health and Human Services, Des Moines, USA"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Iowa Department of Health and Human Services, Des Moines, USA","institution_ids":["https://openalex.org/I2800466922"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5092176293","display_name":"Sai Paritala","orcid":"https://orcid.org/0009-0006-5448-2983","observed_orcids":["https://orcid.org/0009-0006-5448-2983"]},"institutions":[{"id":"https://openalex.org/I1321340555","display_name":"Nebraska Department of Health and Human Services","ror":"https://ror.org/03m7azy07","country_code":"US","type":"government","lineage":["https://openalex.org/I1321340555"]},{"id":"https://openalex.org/I59130452","display_name":"University of Nebraska Medical Center","ror":"https://ror.org/00thqtb16","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I59130452"]}],"countries":["US"],"is_corresponding":true,"raw_author_name":"Sai Paritala","raw_affiliation_strings":["Division of Public Health, Nebraska Department of Health and Human Services","University of Nebraska Medical Center, Lincoln, USA"],"raw_orcid":"https://orcid.org/0009-0006-5448-2983","affiliations":[{"raw_affiliation_string":"Division of Public Health, Nebraska Department of Health and Human Services","institution_ids":["https://openalex.org/I1321340555"]},{"raw_affiliation_string":"University of Nebraska Medical Center, Lincoln, USA","institution_ids":["https://openalex.org/I59130452"]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5102799656","display_name":"Patrick Maloney","orcid":"https://orcid.org/0000-0003-2376-9819","observed_orcids":["https://orcid.org/0000-0003-2376-9819"]},"institutions":[{"id":"https://openalex.org/I1307117695","display_name":"Nebraska Medical Center","ror":"https://ror.org/03azxga02","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I1307117695"]},{"id":"https://openalex.org/I59130452","display_name":"University of Nebraska Medical Center","ror":"https://ror.org/00thqtb16","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I59130452"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Patrick Maloney","raw_affiliation_strings":["Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, USA"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, USA","institution_ids":["https://openalex.org/I1307117695","https://openalex.org/I59130452"]}]}],"institutions":[],"countries_distinct_count":1,"institutions_distinct_count":4,"corresponding_author_ids":["https://openalex.org/A5092176293"],"corresponding_institution_ids":["https://openalex.org/I1321340555","https://openalex.org/I59130452"],"apc_list":{"value":2500,"currency":"USD","value_usd":2500},"apc_paid":{"value":2500,"currency":"USD","value_usd":2500},"fwci":0.0,"has_fulltext":false,"cited_by_count":0,"citation_normalized_percentile":{"value":0.0,"is_in_top_1_percent":false,"is_in_top_10_percent":false},"cited_by_percentile_year":null,"biblio":{"volume":"17","issue":null,"first_page":"21501319261498009","last_page":"21501319261498009"},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T10410","display_name":"COVID-19 epidemiological studies","score":0.9639000296592712,"subfield":{"id":"https://openalex.org/subfields/2611","display_name":"Modeling and Simulation"},"field":{"id":"https://openalex.org/fields/26","display_name":"Mathematics"},"domain":{"id":"https://openalex.org/domains/3","display_name":"Physical Sciences"}},"topics":[{"id":"https://openalex.org/T10410","display_name":"COVID-19 epidemiological studies","score":0.9639000296592712,"subfield":{"id":"https://openalex.org/subfields/2611","display_name":"Modeling and Simulation"},"field":{"id":"https://openalex.org/fields/26","display_name":"Mathematics"},"domain":{"id":"https://openalex.org/domains/3","display_name":"Physical Sciences"}},{"id":"https://openalex.org/T10041","display_name":"COVID-19 Clinical Research Studies","score":0.01140000019222498,"subfield":{"id":"https://openalex.org/subfields/2725","display_name":"Infectious Diseases"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T11296","display_name":"COVID-19 and healthcare impacts","score":0.003100000089034438,"subfield":{"id":"https://openalex.org/subfields/2730","display_name":"Oncology"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/covid-19","display_name":"COVID-19 pandemic","score":0.8479999899864197},{"id":"https://openalex.org/keywords/excess-mortality","display_name":"excess mortality","score":0.984000027179718},{"id":"https://openalex.org/keywords/rurality","display_name":"rurality","score":0.9890000224113464},{"id":"https://openalex.org/keywords/rural-health","display_name":"rural health","score":0.7350000143051147},{"id":"https://openalex.org/keywords/nebraska","display_name":"Nebraska","score":0.6370000243186951},{"id":"https://openalex.org/keywords/covid-19-vaccination","display_name":"COVID-19 vaccination","score":0.9449999928474426},{"id":"https://openalex.org/keywords/covid-19-hospitalization","display_name":"COVID-19 hospitalization","score":0.8629999756813049},{"id":"https://openalex.org/keywords/sarima-model","display_name":"SARIMA","score":0.6639999747276306},{"id":"https://openalex.org/keywords/death-certificate-data","display_name":"death certificate data","score":0.6259999871253967},{"id":"https://openalex.org/keywords/health-disparities","display_name":"health disparities","score":0.5270000100135803}],"concepts":[{"id":"https://openalex.org/C2779465365","wikidata":"https://www.wikidata.org/wiki/Q7380600","display_name":"Rurality","level":3,"score":0.9085000157356262},{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.8027999997138977},{"id":"https://openalex.org/C3018792137","wikidata":"https://www.wikidata.org/wiki/Q6914399","display_name":"Excess mortality","level":3,"score":0.7874000072479248},{"id":"https://openalex.org/C149923435","wikidata":"https://www.wikidata.org/wiki/Q37732","display_name":"Demography","level":1,"score":0.6523000001907349},{"id":"https://openalex.org/C73269764","wikidata":"https://www.wikidata.org/wiki/Q954529","display_name":"Poisson regression","level":3,"score":0.6450999975204468},{"id":"https://openalex.org/C89623803","wikidata":"https://www.wikidata.org/wiki/Q12184","display_name":"Pandemic","level":5,"score":0.5318999886512756},{"id":"https://openalex.org/C99454951","wikidata":"https://www.wikidata.org/wiki/Q932068","display_name":"Environmental health","level":1,"score":0.47940000891685486},{"id":"https://openalex.org/C50440223","wikidata":"https://www.wikidata.org/wiki/Q1475848","display_name":"Risk factor","level":2,"score":0.45890000462532043},{"id":"https://openalex.org/C129047720","wikidata":"https://www.wikidata.org/wiki/Q175185","display_name":"Rural area","level":2,"score":0.4178999960422516},{"id":"https://openalex.org/C22070199","wikidata":"https://www.wikidata.org/wiki/Q192995","display_name":"Vaccination","level":2,"score":0.41620001196861267},{"id":"https://openalex.org/C120195587","wikidata":"https://www.wikidata.org/wiki/Q2138790","display_name":"Absolute risk reduction","level":3,"score":0.4108999967575073},{"id":"https://openalex.org/C97928714","wikidata":"https://www.wikidata.org/wiki/Q7251376","display_name":"Protective factor","level":2,"score":0.3635999858379364},{"id":"https://openalex.org/C2777683767","wikidata":"https://www.wikidata.org/wiki/Q708653","display_name":"Death certificate","level":4,"score":0.36160001158714294},{"id":"https://openalex.org/C2908647359","wikidata":"https://www.wikidata.org/wiki/Q2625603","display_name":"Population","level":2,"score":0.3580000102519989},{"id":"https://openalex.org/C138816342","wikidata":"https://www.wikidata.org/wiki/Q189603","display_name":"Public health","level":2,"score":0.3084999918937683},{"id":"https://openalex.org/C2777126965","wikidata":"https://www.wikidata.org/wiki/Q4880710","display_name":"Behavioral Risk Factor Surveillance System","level":3,"score":0.2948000133037567},{"id":"https://openalex.org/C2777984932","wikidata":"https://www.wikidata.org/wiki/Q7336293","display_name":"Risk of mortality","level":2,"score":0.2872999906539917},{"id":"https://openalex.org/C74909509","wikidata":"https://www.wikidata.org/wiki/Q10387","display_name":"Gerontology","level":1,"score":0.2849000096321106},{"id":"https://openalex.org/C142052008","wikidata":"https://www.wikidata.org/wiki/Q954027","display_name":"Cross-sectional study","level":2,"score":0.2840000092983246},{"id":"https://openalex.org/C107130276","wikidata":"https://www.wikidata.org/wiki/Q133805","display_name":"Epidemiology","level":2,"score":0.271699994802475},{"id":"https://openalex.org/C50382708","wikidata":"https://www.wikidata.org/wiki/Q223218","display_name":"Proportional hazards model","level":2,"score":0.2515999972820282}],"mesh":[{"descriptor_ui":"D000086382","descriptor_name":"COVID-19","qualifier_ui":"Q000401","qualifier_name":"mortality","is_major_topic":true},{"descriptor_ui":"D000086382","descriptor_name":"COVID-19","qualifier_ui":"Q000453","qualifier_name":"epidemiology","is_major_topic":true},{"descriptor_ui":"D000086402","descriptor_name":"SARS-CoV-2","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D005260","descriptor_name":"Female","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D006760","descriptor_name":"Hospitalization","qualifier_ui":"Q000706","qualifier_name":"statistics & numerical data","is_major_topic":false},{"descriptor_ui":"D006801","descriptor_name":"Humans","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D008297","descriptor_name":"Male","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D008875","descriptor_name":"Middle Aged","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D009329","descriptor_name":"Nebraska","qualifier_ui":"Q000453","qualifier_name":"epidemiology","is_major_topic":false},{"descriptor_ui":"D012307","descriptor_name":"Risk Factors","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D012424","descriptor_name":"Rural Population","qualifier_ui":"Q000706","qualifier_name":"statistics & numerical data","is_major_topic":true},{"descriptor_ui":"D058873","descriptor_name":"Pandemics","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false}],"locations_count":3,"locations":[{"id":"doi:10.1177/21501319261498009","doi":"https://doi.org/10.1177/21501319261498009","is_oa":true,"landing_page_url":"https://doi.org/10.1177/21501319261498009","pdf_url":null,"source":{"id":"https://openalex.org/S59821943","display_name":"Journal of Primary Care & Community Health","issn_l":"2150-1319","issn":["2150-1319","2150-1327"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["cwts-core","doaj","jufo-1","ki-jl-1","medline","norway-1","poland-40","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310320017","host_organization_name":"SAGE Publishing","host_organization_lineage":["https://openalex.org/P4310320017"],"host_organization_lineage_names":["SAGE Publishing"],"type":"journal"},"license":"cc-by-nc","license_id":"https://openalex.org/licenses/cc-by-nc","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Journal of Primary Care & Community Health","raw_type":"journal-article"},{"id":"pmid:42880764","doi":null,"is_oa":false,"landing_page_url":"https://pubmed.ncbi.nlm.nih.gov/42880764","pdf_url":null,"source":{"id":"https://openalex.org/S4306525036","display_name":"PubMed","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Journal of primary care & community health","raw_type":"Journal Article"},{"id":"pmh:oai:doaj.org/article:af028d6b4a514cd1b2e10b515a431b55","doi":null,"is_oa":false,"landing_page_url":"https://doaj.org/article/af028d6b4a514cd1b2e10b515a431b55","pdf_url":null,"source":{"id":"https://openalex.org/S4306401280","display_name":"DOAJ (DOAJ: Directory of Open Access Journals)","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":null,"host_organization_name":null,"host_organization_lineage":[],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"submittedVersion","is_accepted":false,"is_published":false,"raw_source_name":"Journal of Primary Care & Community Health, Vol 17 (2026)","raw_type":"article"}],"best_oa_location":{"id":"doi:10.1177/21501319261498009","doi":"https://doi.org/10.1177/21501319261498009","is_oa":true,"landing_page_url":"https://doi.org/10.1177/21501319261498009","pdf_url":null,"source":{"id":"https://openalex.org/S59821943","display_name":"Journal of Primary Care & Community Health","issn_l":"2150-1319","issn":["2150-1319","2150-1327"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["cwts-core","doaj","jufo-1","ki-jl-1","medline","norway-1","poland-40","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310320017","host_organization_name":"SAGE Publishing","host_organization_lineage":["https://openalex.org/P4310320017"],"host_organization_lineage_names":["SAGE Publishing"],"type":"journal"},"license":"cc-by-nc","license_id":"https://openalex.org/licenses/cc-by-nc","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Journal of Primary Care & Community Health","raw_type":"journal-article"},"sustainable_development_goals":[{"id":"https://metadata.un.org/sdg/3","score":0.9537000060081482,"display_name":"Good health and well-being"}],"study_designs":[{"id":"https://openalex.org/study-designs/observational-study","display_name":"Observational Study"}],"awards":[],"funders":[],"has_content":{"grobid_xml":false,"pdf":false},"content_urls":null,"referenced_works_count":18,"referenced_works":["https://openalex.org/W1824543798","https://openalex.org/W3034446411","https://openalex.org/W3041631412","https://openalex.org/W3090486838","https://openalex.org/W3098381977","https://openalex.org/W3100701839","https://openalex.org/W3128978812","https://openalex.org/W3130743400","https://openalex.org/W3158325128","https://openalex.org/W3160434659","https://openalex.org/W3195344687","https://openalex.org/W4214866558","https://openalex.org/W4225352214","https://openalex.org/W4280518803","https://openalex.org/W4297037052","https://openalex.org/W4311589142","https://openalex.org/W4389608733","https://openalex.org/W4401587363"],"related_works":["https://openalex.org/W4389608733","https://openalex.org/W4225352214","https://openalex.org/W4381798595","https://openalex.org/W4292117455","https://openalex.org/W7213667512","https://openalex.org/W4414945318","https://openalex.org/W4411049865","https://openalex.org/W3097103309","https://openalex.org/W4385918366","https://openalex.org/W4400234888"],"abstract_inverted_index":{"Introduction/ObjectivesThe":[0],"COVID-19":[1,47,63,134],"pandemic":[2,48,165],"increased":[3],"mortality":[4,44,108,163,190],"across":[5,14,164],"the":[6,38,46,157,168,172],"United":[7],"States,":[8],"but":[9],"its":[10],"burden":[11],"was":[12,109,156,176,183],"uneven":[13],"communities.":[15],"Rural":[16],"populations":[17],"may":[18],"be":[19],"vulnerable":[20],"because":[21],"of":[22,131],"differences":[23],"in":[24,49,191],"age":[25],"structure,":[26],"health":[27],"care":[28,200],"access,":[29],"preventive":[30],"behaviors,":[31],"and":[32,42,66,69,126,137,146,202],"vaccination":[33,67,138],"uptake.":[34],"This":[35],"study":[36,52],"examined":[37],"association":[39,170],"between":[40,124],"rurality":[41,125],"excess":[43,127,153,162,181,189],"during":[45,171],"Nebraska.MethodsThis":[50],"ecological":[51],"used":[53,82],"Nebraska":[54],"death":[55],"certificate":[56],"data":[57],"from":[58,77,92],"2015":[59,78],"through":[60,79,96],"May":[61,97],"2023,":[62,99],"laboratory,":[64],"hospitalization,":[65,136],"data,":[68],"American":[70],"Community":[71],"Survey":[72],"sociodemographic":[73],"data.":[74],"Monthly":[75],"deaths":[76,86,145],"2019":[80],"were":[81],"to":[83,151],"forecast":[84],"expected":[85,114,148],"by":[87],"zip":[88],"code":[89],"tabulation":[90],"area":[91],"January":[93],"1,":[94],"2020,":[95],"31,":[98],"using":[100,119],"seasonal":[101],"autoregressive":[102],"integrated":[103],"moving":[104],"average":[105],"models.":[106],"Excess":[107],"calculated":[110],"as":[111,140],"observed":[112,144],"minus":[113],"deaths.":[115,154],"Secondary":[116],"regression":[117,121],"analysis":[118],"Poisson":[120],"assessed":[122],"associations":[123],"mortality,":[128],"with":[129,167,179],"inclusion":[130],"demographic,":[132],"socioeconomic,":[133],"infection,":[135],"measures":[139],"covariates.ResultsNebraska":[141],"had":[142],"63,333":[143],"57,865":[147],"deaths,":[149],"corresponding":[150],"5,468":[152],"Rurality":[155],"strongest":[158,169],"associated":[159,178],"factor":[160,187],"for":[161,188],"phases,":[166],"pre-vaccine":[173],"phase.":[174],"Vaccination":[175],"generally":[177],"reduced":[180],"mortality.ConclusionsRurality":[182],"an":[184],"important":[185],"risk":[186],"Nebraska.":[192],"Findings":[193],"support":[194],"targeted":[195],"rural":[196],"surveillance,":[197],"outreach,":[198],"primary":[199],"engagement,":[201],"emergency":[203],"preparedness.":[204]},"counts_by_year":[],"updated_date":"2026-11-08T12:12:28.789561","created_date":"2026-10-16T00:00:00"}