Dissertations & Theses (Open Access)

Date of Award

Spring 5-2023

Degree Name

Master of Public Health (MPH)



Second Advisor



Understanding the health disparities associated with SARS-CoV-2 antibody status across Texas is essential. These differences can guide healthcare professionals and local public health officials to identify vulnerable populations needing COVID-19 prevention and treatment resources. This study aims to contribute to the literature by determining if rural and urban geographical locations are disproportionately impacted by SARS-CoV-2 infection and vaccination in the state of Texas. I utilized the Texas Coronavirus Antibody REsponse Survey (Texas CARES), a large ongoing prospective population-based survey among 5–90-year-olds from the Texas general population that began collecting seroprevalence data in October 2020 (1). Participants in the survey are currently offered a series of 4 SARS-CoV-2 antibody tests over 12+ months or about every three months. The cohort provided the data needed to describe the prevalence of SARS-CoV-2 antibodies from both natural and vaccine-induced infection and vaccination status. Additionally, each county in Texas was categorized as either rural or urban, and each participant was described as residing in a rural or urban setting based on their mailing address. Chi-square analysis determined any statistical differences in seroprevalence (positive/negative) by rural and urban status. Texas CARES utilizes two antibody blood tests. The S test, or COVID-19 Antibodies, Spike Protein detects antibodies from a past COVID-19 infection and/or vaccination (positive range 08-2500U/mL). The N test or SARS-CoV-2 Total Antibodies detects antibodies from a past COVID-19 infection (positive range > 1.0). Rural participants had a higher percentage of positive N test results for their first (T1, October/2020) and their fourth (T4, July/2022), 37.00% and 65.40%, respectively. In contrast, urban participants had seropositivity of 20.19% and 55.33% for T1 and T4 N test respectively. Therefore, more rural individuals had antibodies from a natural infection at that point in time than urban individuals. Both rural and urban individuals had a 97% seroprevalence for their T4 S test, indicating nearly all individuals have some degree of protection against COVID-19. Nearly three-fourths of urban participants were fully vaccinated (45.18%) or fully vaccinated and boosted (30.28%). About half of rural participants were fully vaccinated or fully vaccinated (37.74%) and boosted (16.28%). Within the rural population, 27.32% of participants are not vaccinated, compared to 11.41% of unvaccinated participants in urban counties.

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