Is Rural Kansas Prepared? An Assessment of Resources Related to the COVID-19 Pandemic

INTRODUCTION. This study investigated rural Kansas healthcare system capacity and critical care-related resources relevant to the care of COVID-19 patients in at the county level in the context of population characteristics. METHODS. The federal Area Health Resource File was used to assess system capacity and critical care-related resources and COVID-19-related population risk factors at the county level. Data were described with summary statistics, cross-tabulations, and bivariate tests to discern differences across frontier, rural, and urban counties using 2013 Rural-Urban Continuum Code classifications. RESULTS. Kansas has 105 counties. Urban counties had an average of 2 physicians per 1,000 people, while rural and frontier counties had 1. 63.5% of frontier counties had no anesthesia providers and 100.0% of frontier counties had no pulmonary disease physicians. While 96 counties have at least one hospital, nearly 90% frontier counties had no ICU services. The percent of the population estimated to be over 65 was higher among frontier counties (24.2%) than urban counties (19.3%). On average, frontier counties had approximately twice as many deaths per 1,000 people by cardiovascular diseases and COPD than urban and `rural counties. CONCLUSIONS. Our findings showed that Kansas faces limited ICU capabilities and physician workforce shortages in frontier counties, both in primary care and specialties such as anesthesia and pulmonology. In addition, rural and frontier population age structures and mortality rates demonstrate an increased risk to potentially overwhelm local healthcare systems. This may have serious implications for rural health, particularly in the context of the COVID-19 pandemic.