Department of Medicine, Cambridge Health Alliance, Cambridge, Massachusetts.
Harvard Medical School, Boston, Massachusetts.
J Rural Health. 2022 Jan;38(1):207-216. doi: 10.1111/jrh.12525. Epub 2020 Oct 11.
The burden of chronic obstructive pulmonary disease (COPD) is high in rural America. Few studies, however, have examined urban/rural differences in health care access, or racial/ethnic and income disparities stratified by urban/rural residence, among persons with COPD.
We studied individuals age ≥ 40 years with COPD from the 2018 Behavioral Risk Factor Surveillance System. The primary exposure was "urban" or "rural" county of residence. We examined multiple health and health care access/services outcomes using logistic regressions adjusted for age and sex, and performed analyses stratified by rural/urban county that included additional adjustment for race/ethnicity or income.
Our sample included 34,439 individuals. COPD prevalence was 8.6% in rural counties versus 5.4% in urban counties. Rural residents with COPD were poorer, had less education, worse health, and more disability. Of the rural population with COPD, 12.6% were uninsured, versus 10.4% in urban areas (AOR 1.26; 95% CI: 1.00-1.58). Rural residents with COPD were more likely to have not seen a doctor due to cost (AOR 1.18; 95% CI: 1.02-1.36). Differences in other outcomes were mostly nonsignificant. We observed large access disparities by race/ethnicity and income among individuals in both urban and rural counties, with the highest rates of forgone care among minorities in rural counties.
Patients with COPD in rural areas experience greater morbidity and obstacles to care than those in urban areas. Racial/ethnic minorities and those with low incomes-particularly in rural areas-are also at greater risk of forgoing doctor visits due to cost. Expanded access to health care could address respiratory health inequities.
美国农村地区慢性阻塞性肺疾病（COPD）负担沉重。然而，很少有研究检查过城市/农村地区在医疗保健获取方面的差异，也没有研究过按城市/农村居住地分层的 COPD 患者的种族/民族和收入差距。
我们研究了来自 2018 年行为风险因素监测系统的年龄≥40 岁的 COPD 患者。主要暴露因素是居住的“城市”或“农村”县。我们使用经过年龄和性别调整的逻辑回归检查了多种健康和医疗保健获取/服务结果，并对农村/城市县进行了分析，包括对种族/民族或收入的进一步调整。
我们的样本包括 34439 人。农村县 COPD 的患病率为 8.6%，而城市县为 5.4%。患有 COPD 的农村居民更贫困、受教育程度更低、健康状况更差、残疾程度更高。在农村 COPD 人群中，12.6%的人没有保险，而城市地区为 10.4%（AOR 1.26；95%CI：1.00-1.58）。由于费用原因，农村 COPD 患者看医生的可能性更小（AOR 1.18；95%CI：1.02-1.36）。其他结果的差异大多不显著。我们观察到城市和农村县的个体之间存在很大的获取障碍，种族/民族和收入较低的个体，特别是农村县的个体，放弃治疗的比例更高。
农村地区 COPD 患者的发病率和治疗障碍比城市地区患者更大。少数民族和低收入者——特别是农村地区的低收入者——由于费用原因，更有可能不去看医生。扩大医疗保健的获取可以解决呼吸道健康方面的不平等问题。
