Only 11% of physicians practice in rural areas, many of which are designated as Health Care Shortage Areas. COPD-related mortality is high in many rural/frontier counties of Colorado, yet very little is known about how these patients differ from their urban counterparts. Accordingly, we sought to determine whether differences in treatment or population characteristics could provide insight into the increased mortality seen in rural populations.
Six hundred twelve GOLD stage 3 or 4 patients were enrolled throughout Colorado. Patient characteristics and clinical variables were obtained. Subjects were classified based on residence in either urban (n = 428) or rural settings (n = 184).
Rural and urban populations were similar in terms of age, gender and race. BMI, pack-years of tobacco use, MMRC Dyspnea Scale and six-minute walk distance were also similar. A small but statistically significant difference was seen in FEV1 (% predicted) that likely does not have clinical meaning (37.0% urban vs. 39.7% rural). Similar rates of other comorbidities such as heart failure, hypertension and diabetes were seen. In contrast, rural subjects achieved less formal education and tended to live alone (p = 0.08). Fewer rural subjects were prescribed short acting bronchodilator therapy or inhaled corticosteroids, and a similar trend was present for long-acting bronchodilator therapy (p = 0.10). Fewer rural subjects received adequate preventative therapies such as the influenza vaccination and fewer had ever participated in pulmonary rehabilitation. Rural patients had fewer ER visits and hospital or ICU admissions for COPD-related problems, yet rates of urgent office visits for COPD were similar between the two groups. This fact might suggest less access to these higher levels of care for rural patients.
Increased COPD-related mortality in rural patients may be due to a constellation of disparities, including decreased prevention, inadequate medical and non-medical therapies, reduced access to acute care facilities and less specialized services such as ICU care and pulmonary rehabilitation.
Improving the numerous disparities between rural and urban populations may alter high mortality rates in rural Colorado due to COPD.
Derek Linderman, No Financial Disclosure Information; No Product/Research Disclosure Information