• Christopher A Czaja, Myles G Cockburn, Kathryn Colborn, Lisa Miller, Deborah S K Thomas, Rachel K Herlihy, Nisha Alden, and SimõesEric A FEAFColorado School of Public Health, Aurora, CO 80045, USA; University of Colorado School of Medicine, 13001 E. 17th Pl., Aurora, CO 80045, USA..
• Colorado Department of Public Health and Environment, 4300 Cherry Creek Drive S., Denver, CO 80246, USA; Colorado School of Public Health, Aurora, CO 80045, USA; University of Colorado School of Medicine, 13001 E. 17th Pl., Aurora, CO 80045, USA. Electronic address: chris.czaja@cuanschutz.edu.
• Prev Med. 2020 Oct 1; 139: 106184.

AbstractThe burden of influenza in rural areas is largely unstudied. Rural populations may be vulnerable yet isolated from circulating virus. Laboratory-confirmed influenza hospitalizations in rural Colorado census tracts over eight influenza seasons were inconsistently distributed across seasons. Rural rates were, on average, lower than urban rates. Race, ethnicity, poverty, health insurance coverage, and distance from a hospital accounted for rate differences. Our interpretation is: 1) influenza regularly circulates in urban areas and inconsistently spreads to rural areas, 2) demographic and socioeconomic factors drive morbidity in exposed populations, and 3) public health interventions targeting high-risk urban census tracts may be beneficial.Copyright © 2020 Elsevier Inc. All rights reserved.

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