Rural living with COPD is risky

Living in a rural area with chronic obstructive pulmonary disease (COPD) puts patients at higher-risk for dying of a COPD exacerbation, a US Veterans Affairs study shows.

Recent studies have suggested a link between rural residence and worse health outcomes. To see whether rural patients with COPD suffer from a disparity, Dr Thad E. Abrams from the Iowa City VA Medical Center and colleagues looked at data from 129 VA medical centres on more than 26,000 patients hospitalised for COPD flares.

There were 18,809 patients from urban areas, 5,671 from rural areas, and 1,919 from isolated rural areas.

Unadjusted flare-related mortality rates were higher for patients from isolated rural areas (5.0%) and rural areas (4.0%) than for patients from urban areas (3.8%; p=0.002). according to findings scheduled to appear in the Annals of Internal Medicine.

Patient volume mattered too. Flare-related mortality was higher in rural hospitals with fewer COPD admissions. Mortality rates were similar, however, in major rural hospitals with higher volumes of COPD admissions.

Equal distribution of services needed

After adjustment for clinical characteristics, the proportion of COPD hospital admissions coming from rural areas, and the volume of COPD admissions, patients from isolated rural areas (but not from rural areas) had a 42% increased risk for death due to an exacerbation of their disease.

Surprisingly, longer distances to travel to the nearest VA medical centre were associated with lower 30-day mortality.

"A possible explanation for this effect is that veterans who live farther away from a VA medical centre have to be well enough to tolerate travelling the longer distance for care," the researchers suggest.

Limitations of the study include having a mostly male population of inpatient veterans with numerous comorbid conditions and relying solely on administrative data sources that did not include important disease-specific physiologic variables.

"We believe that workforce and policy leaders need to be aware of this difference, as a first step toward more equitable distribution of resources shown to be associated with variations in mortality, such as board-certified pulmonary staff and ventilatory support resources," the investigators say.

"Perhaps more importantly," they conclude, "further research is needed to highlight which specific resources rural patients lack, and to substantiate these findings by using spatial techniques to define (rural residence) at a more granular level."

(Reuters Health, July 2011) 

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