Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, AL 35205, USA.
J Rural Health. 2013 Aug;29 Suppl 1(0 1):s62-9. doi: 10.1111/jrh.12005. Epub 2013 Feb 22.
Limited evidence in the United States suggests that among patients with chronic obstructive pulmonary disease (COPD), rural residence is associated with higher hospitalization rates and increased mortality. However, little is known about the reasons for these disparities. This study's purpose was to describe the health status of rural versus urban residence among patients with COPD and to examine factors associated with differences between these 2 locations.
This was a cross-sectional study of baseline data from a representative sample of patients with COPD enrolled in a clinical trial. Rural-urban residence was determined from ZIP code. Health status was measured using the SF-12 and health care utilization. Independent sample t-tests, chi-square tests, and multiple linear and logistic regressions were performed to examine differences between rural and urban patients.
Rural residence was associated with poorer health status and higher health care utilization. Among rural patients unadjusted physical functioning scores were lower on the SF-12 (30.22 vs 33.49; P = .005) that persisted after adjustment for potential confounders (β = -2.35; P = .04). However, after further adjustment for social and psychological factors only the body-mass index, airflow obstruction, dyspnea, and exercise (BODE) index was significantly associated with health status.
In this representative sample of patients with COPD rural residence was associated with worse health status, primarily associated with greater impairment as measured by BODE index. While rural patients reported a higher dose of smoking, a number of other unmeasured factors associated with rural residence may contribute to these disparities.
美国的有限证据表明，在慢性阻塞性肺疾病（COPD）患者中，农村居住与更高的住院率和死亡率增加有关。然而，对于这些差异的原因知之甚少。本研究的目的是描述 COPD 患者的农村与城市居住的健康状况，并研究与这两个地点之间差异相关的因素。
这是一项对 COPD 患者临床试验的代表性样本的基线数据进行的横断面研究。农村-城市居住通过邮政编码确定。健康状况使用 SF-12 和医疗保健利用来衡量。进行独立样本 t 检验、卡方检验以及多元线性和逻辑回归，以检查农村和城市患者之间的差异。
农村居住与较差的健康状况和更高的医疗保健利用率相关。在未经调整的情况下，农村患者的 SF-12 身体机能得分较低（30.22 对 33.49；P=0.005），调整潜在混杂因素后仍持续存在（β=-2.35；P=0.04）。然而，进一步调整社会和心理因素后，只有体重指数、气流阻塞、呼吸困难和运动（BODE）指数与健康状况显著相关。
在这个具有代表性的 COPD 患者样本中，农村居住与较差的健康状况相关，主要与 BODE 指数测量的更大损害有关。尽管农村患者报告了更高的吸烟剂量，但与农村居住相关的许多其他未测量的因素可能导致了这些差异。
