NASHVILLE (AP) — Most of Tennessee's new reported COVID-19 cases and hospitalizations are now outside of the Nashville and Memphis metro areas, according to a report released Monday.

The Vanderbilt University report says Tennessee's outbreak began concentrated in large urban areas but has moved into more rural communities with fewer health care resources.

"Understanding this shift is critical for targeting resources and preparing to address increasing needs for services and effects on rural health care systems," the report says. "As a largely rural state, Tennessee stands to be among the states most affected by this shift."

The report says that there are high overall numbers of new reported cases, so it doesn't necessarily mean large metros are seeing fewer cases than earlier in the pandemic.

Researchers wrote that cases and hospitalizations appear to be stable in large urban areas, while many small metro areas continue to see growth.

Additionally, the report says new cases and hospitalizations are stable in areas with increased mask usage, while areas without mask orders have seen increases. Other strategies could also be contributing, the report says.

"While these data do not establish a causal relationship, they are consistent with other research about the efficacy of masks at reducing transmission of COVID-19," it says.