Warner Jacob S, Bryan Jane M, Paulin Laura M
Department of Internal Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, United States.
Dartmouth College, Hanover, New Hampshire, United States.
Chronic Obstr Pulm Dis. 2022 Oct 26;9(4):500-509. doi: 10.15326/jcopdf.2022.0299.
Individuals in rural areas of the United States have a greater risk of chronic obstructive pulmonary disease (COPD) and have worse COPD outcomes. New Hampshire (NH) is split between non-rural and rural counties.
We examined differences in COPD exacerbation rates ([encounters per county/county population of 35 years of age and older] × 100), length of stay (LOS), and total charges by rurality, determined by the 2013 National Center for Health Statistics rural-urban classification. Linear regression analysis determined the association of rural status on COPD outcomes, adjusting for age, gender, insurance status, and county-level smoking prevalence.
A total of 15,916 encounters were analyzed, of which 5805 were inpatient and 10,111 were from the emergency department, 7058 (44%) were male, and the mean age was 65.6. A total of 31% were from large, fringe metro counties, 25.9% were from medium metro counties, 37.6% were from micropolitan counties, and 5.5% were from non-core counties. In multivariable regression, rural counties had higher COPD exacerbation rates compared to urban counties (non-core beta=0.18, [confidence interval (CI) 0.16, 0.20]; micropolitan beta=0.02, CI [0.01, 0.03]); medium metro counties (beta=-0.07, Cl [-0.09, -0.06]) had lower rates of COPD exacerbations ( < 0.001 for all). Compared to urban counties, encounters from rural counties had lower total charges (medium metro beta=-1695 [-2410, -980]; micropolitan beta=-2701 [-3315, -2088]; non-core beta=-4453 [-5646, -3260], all <0.001). LOS did not differ by rurality.
Accounting for poverty and other sociodemographic factors, the rates of COPD exacerbation encounters were higher in rural versus non-rural NH counties. Additionally, non-rural areas carried higher total charges, potentially due to more resource availability. These results support the need for future interventions to improve outcomes in rural COPD patients.
美国农村地区的居民患慢性阻塞性肺疾病（COPD）的风险更高，且COPD的病情转归更差。新罕布什尔州（NH）分为非农村县和农村县。
我们根据2013年国家卫生统计中心的城乡分类标准，研究了按农村地区划分的COPD急性加重率（[每个县的就诊次数/35岁及以上的县人口数]×100）、住院时间（LOS）和总费用的差异。线性回归分析确定了农村地区状况与COPD病情转归之间的关联，并对年龄、性别、保险状况和县级吸烟率进行了调整。
共分析了15916次就诊，其中5805次为住院患者，10111次来自急诊科，7058例（44%）为男性，平均年龄为65.6岁。共有31%来自大型边缘都市县，25.9%来自中型都市县，37.6%来自微型都市县，5.5%来自非核心县。在多变量回归中，与城市县相比，农村县的COPD急性加重率更高（非核心县β=0.18，[置信区间（CI）0.16，0.20]；微型都市县β=0.02，CI[0.01，0.03]）；中型都市县（β=-0.07，Cl[-0.09，-0.06]）的COPD急性加重率较低（所有P<0.001）。与城市县相比，农村县的就诊总费用较低（中型都市县β=-1695[-2410，-980]；微型都市县β=-2701[-3315，-2088]；非核心县β=-4453[-5646，-3260]，所有P<0.001）。住院时间在农村地区无差异。
考虑到贫困和其他社会人口因素，NH农村县的COPD急性加重就诊率高于非农村县。此外，非农村地区的总费用更高，这可能是由于资源更丰富。这些结果支持未来需要采取干预措施以改善农村COPD患者的病情转归。
