Why were towns hit harder than rural areas during the Black Death?

During the Black Death, towns were hit harder than rural areas primarily due to their dense living conditions and poor sanitation infrastructure.1

In medieval cities, people lived in crowded environments that often included many animals, which facilitated the rapid spread of the plague. Because the disease is caused by the bacterium Yersinia pestis and transmitted to humans by fleas living on rodents, the close proximity of humans to these animals in urban centers created ideal conditions for transmission. Furthermore, cities served as hubs for trade routes, which acted as primary vectors for the disease to enter and circulate among concentrated populations.1234

In response to the devastation, public officials began developing early public health systems, including quarantine measures, improved waste disposal, and food inspection, to better manage the unsanitary conditions that exacerbated these outbreaks.1