Rural residents face greater risks of severe sickness and death from COVID-19, due in part to factors like age, illness, disability, health insurance and access to intensive care.

Yet a new Centers for Disease Control and Prevention report finds rural vaccination rates still lag — though not in Arizona.

From December to April, first-dose vaccination coverage in the U.S. reached just below 39% in rural counties versus almost 46% in urban.

Arizona reversed that pattern, with a 59% rural rate and an almost 44% urban rate, perhaps partly due to the sorting system, which listed only seven Arizona counties as rural.

“They use a definition that includes only seven of our rural counties. Whereas, being from Arizona, I would consider 13 of our counties to be rural,” said Dr. Cara Christ, director of the Arizona Department of Health Services.

Counties categorized as rural included Apache, Gila, Graham, Greenlee, La Paz, Navajo and Santa Cruz. By that classification, Arizona led the nation in rural county vaccination rates.

Christ said rural counties are doing well, and that her department is working with their leaders to distribute the more sensitive Pfizer vaccine, which is the only one approved for 12- to 18-year-olds.

"Local health departments and the boots on the ground have done a great job vaccinating in those counties."

Because the study analyzed only the first dose of the two-dose Pfizer and Moderna vaccines or the only dose for the single-dose Johnson & Johnson vaccine, the authors capped the number of doses at each county's population size.

According to the U.S. census, about 60 million people, or roughly one-fifth of the U.S. population, live in rural counties.

A March 2021 poll by the Kaiser Family Foundation reported 21% of rural residents said they would "definitely not" get a vaccine compared with 10% of urban residents.

The authors call for public health personnel to work with rural partners to overcome vaccination barriers.