PURPOSE:Colorado is one of six Rocky Mountain States with high COPD-related mortality. Patients residing in rural areas within Colorado have a higher mortality rate compared to urban areas. We sought to determine whether population characteristics or treatment differences could provide insight into the increased mortality seen in rural populations.
METHODS:Five hundred eleven GOLD stage 3 or 4 patients were enrolled throughout the state. Patient characteristics and clinical variables were obtained. Subjects were categorized based on residence in either urban (n= 402) or rural settings (n=109).
RESULTS:Rural and urban populations did not differ in regard to demographics or measurements of disease severity, such as age, pack-years of tobacco use, FEV1 (% predicted), six-minute walk distance, BODE index or St. George's Respiratory Questionnaire. In contrast, rural patients had a higher prevalence of COPD risk factors, including occupational exposures and lower socioeconomic status (i.e. increased Medicaid enrollment). Rural subjects used alternative medications more frequently, were prescribed less short acting bronchodilator therapy, and had a trend toward less inhaled corticosteroid use(P=0.08). Interestingly, both groups had similar low rates of long-acting β2-agonist and anti-cholinergic use. Rural subjects were less likely to have received adequate preventative or non-medical therapies, including the influenza vaccination, pulmonary rehabilitation or a chest radiograph. Although no significant difference was seen in the number of hospital admissions or length of stay, the rural group was significantly less likely to receive ICU care or mechanical ventilation (either invasive or non-invasive ventilatory support). Finally, rural subjects were more likely to live alone, and less likely to have advance directives or a medical power of attorney.
CONCLUSION:Increased COPD-related mortality in rural patients may be due to a constellation of disparities, including increased COPD risk factors, decreased prevention, inadequate medical and non-medical therapies, and the reduced availability of specialized services such as ICU care, mechanical ventilation and pulmonary rehabilitation.
CLINICAL IMPLICATIONS:Improving the numerous disparities between rural and urban populations may alter high mortality rates in Colorado due to COPD.
DISCLOSURE:Tammie Freitag, No Financial Disclosure Information; No Product/Research Disclosure Information