State variations in chronic obstructive pulmonary disease (COPD) outcomes suggest that the condition is more common in large rural areas compared with metropolitan areas, according to the Morbidity and Mortality Weekly Report
The report analyzed 2015 data from the Behavioral Risk Factor Surveillance System, Medicare hospital records, and death certificate data from the National Vital Statistics System, and identified 15.5 million adults who received a COPD diagnosis with approximately 335,000 Medicare hospitalizations and 150,350 deaths in which COPD was the underlying cause.
The analysis found that COPD prevalence, Medicare hospitalizations, and deaths were “significantly higher” among people in rural areas compared with people in other areas of the country.
Age-adjusted prevalence of COPD diagnosis ranged from 4.7% among populations in large metropolitan centers to 8.2% in rural areas. The analysis also found that 7 states were in the highest quartiles for COPD prevalence, Medicare hospitalizations, and deaths: Alabama, Arkansas, Indiana, Kentucky, Mississippi, Tennessee, and West Virginia. Of those 7 states, Arkansas, Mississippi, and West Virginia were also in the highest quartile for percentage of rural residents.
The researchers speculated that rural populations had a higher risk of COPD because they have a greater proportion with a history of smoking, less access to smoking cessation programs, and higher proportions of uninsured or lower socioeconomic residents. Barriers to care in these areas include cultural perceptions about seeking care, distance to travel for care, a lack of services available, and financial burden. Limited access to services also affects access to early diagnosis, prompt treatment, and management of COPD.
“Healthcare providers and community partners who serve rural residents can help adults with COPD increase access to and participation in healthcare interventions,” the authors concluded. “Federal agencies are promoting collaborative and coordinated efforts to educate the public, providers, patients, and caregivers about COPD and improve the prevention, diagnosis, and treatment of COPD.”
Croft JB, Wheaton AG, Liu Y, et al. Urban-rural county and state differences in chronic obstructive pulmonary disease—United States, 2015. MMWR Morb Mortal Wkly Rep
. 2018:67(7);205-211. doi: http://dx.doi.org/10.15585/mmwr.mm6707a1.