Geographic Isolation and the Risk for Chronic Obstructive Pulmonary Disease-Related Mortality

University of Washington Seattle, Seattle, Washington, United States
Annals of internal medicine (Impact Factor: 17.81). 07/2011; 155(2):80-6. DOI: 10.1059/0003-4819-155-2-201107190-00003
Source: PubMed


Little is known about the possible differences in outcomes between patients with chronic obstructive pulmonary disease (COPD) who live in rural areas and those who live in urban areas of the United States.
To determine whether COPD-related mortality is higher in persons living in rural areas, and to assess whether hospital characteristics influence any observed associations.
Retrospective cohort study.
129 acute care Veterans Affairs hospitals.
Hospitalized patients with a COPD exacerbation.
Patient rurality (primary exposure); 30-day mortality (primary outcome); and hospital volume and hospital rurality, defined as the mean proportion of hospital admissions coming from rural areas (secondary exposures).
18,809 patients (71% of the study population) lived in urban areas, 5671 (21%) in rural areas, and 1919 (7%) in isolated rural areas. Mortality was increased in patients living in isolated rural areas compared with urban areas (5.0% vs. 3.8%; P = 0.002). The increase in mortality associated with living in an isolated rural area persisted after adjustment for patient characteristics and hospital rurality and volume (odds ratio [OR], 1.42 [95% CI, 1.07 to 1.89]; P = 0.016). Adjusted mortality did not seem to be higher in patients living in nonisolated rural areas (OR, 1.09 [CI, 0.90 to 1.32]; P = 0.47). Results were unchanged in analyses assessing the influence of an omitted confounder on estimates.
The study population was limited to mostly male inpatients who were veterans. Results were based on administrative data.
Patients with COPD living in isolated rural areas of the United States seem to be at greater risk for COPD exacerbation-related mortality than those living in urban areas, independent of hospital rurality and volume. Mortality was not increased for patients living in nonisolated rural areas.
U.S. Department of Veterans Affairs.

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    • "The negative effects of chronic illness include functional impairment, limited mobility, and poorer quality-of-life (QOL) [3]. Chronic obstructive pulmonary disease (COPD) patients, afflicted by the third leading cause of mortality [4], face significant challenges in accessing healthcare services, due to the presence of comorbidities [5], limited mobility [6], advanced age, the effects of social isolation, and often rural residency [7]. All of these factors create additional needs, many of which go unmet by the healthcare system. "
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    BMC Pulmonary Medicine 04/2014; 14(1):66. DOI:10.1186/1471-2466-14-66 · 2.40 Impact Factor
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    • "Individual barriers identified in some studies include the need to make changes in the daily routine, competing needs and duties, and transportation problems [28]. Social isolation and living in remote areas is common in COPD patients, with up to 28% of Veterans with COPD residing in rural and isolated areas [29]. Living in rural or isolated areas is associated with a lower probability of receiving home health services and less frequent visits to physicians [30]. "
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