Mortality Rates in COPD Decline for All Groups Except Rural Women

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In COPD, rural women continue to experience a higher burden than urban women regarding other health conditions, access to care, and poverty.

“Mortality rates for men and urban women with [COPD] have been declining, while mortality rates for rural women have been increasing,” Arianne Baldomero, MD, and colleagues wrote. “The reason for this trend is poorly understood.”

For a study presented at CHEST 2024, Dr. Baldomero and colleagues assessed geographic disparities that may influence poor COPD outcomes for rural versus urban women with the condition. “We hypothesized that there could be environmental, social, and health factor differences between rural and urban women with COPD that contribute to increasing mortality rates,” the researchers wrote.

The retrospective analysis utilized national data from the Veterans Health Administration to identify women with COPD, defined as two or more ICD codes for COPD from 2016 to 2019. The researchers used the Environmental Justice Index (EJI), a tool from the CDC that measures the impact of 36 environmental, social, and health factors, to examine disparities in COPD outcomes.

Results 

The study included 50,042 women with COPD, most of whom (67%) lived in urban compared with rural areas (33%).

The EJI score was higher among rural women versus urban women (55.8 ±25.8 vs 52.9 ±29.0; P<0.001), indicating a greater burden, according to the study findings. Compared with urban women, rural women also had higher scores on modules assessing social vulnerability (58.2 ±22.8 vs 55.0 ±27.1; P<0.001) and health vulnerability (50.2±32.2 vs. 33.5 ±30.6; P<0.001).

In further comparisons with urban women, Dr. Baldomero and colleagues found that rural women were:

• more likely to live in areas with higher poverty (58.8 ±21.2 vs 54.4 ±26.7; P<0.001);
• more often uninsured (56.1 ±24.6 vs 55.6 ±26.9; P<0.001);
• more likely to have less Internet access (65.5 ±22.0 vs 48.7 ±49.2; P<0.001); and
• more often living in mobile homes (76.9 ±22.8 vs 40.2 ±35.5; P<0.001).

Regarding burdens related to other health conditions, rural women with COPD faced greater burdens than urban women for:

• asthma (43.1 ±49.5 vs 34.2 ±47.5; P<0.001);
• hypertension (60.2 ±49.0 vs 36.7 ±48.2; P<0.001);
  • cancer (51.1 ±50.5 vs 25.9 ±43.8; P<0.001);
  • diabetes (50.1 ±50.0 vs 33.7 ±47.3; P<0.001); and
  • mental health (46.5 ±50.0 vs 36.8 ±48.2; P<0.001).

Implications  

“In this national cohort of women with COPD, living in a rural area was associated with a worse EJI, particularly in the domains of social vulnerability (high poverty, lack of insurance, and poor internet access) and health vulnerability,” Dr. Baldomero and colleagues wrote. “Disparities in access to [healthcare] among rural women with COPD are likely associated with overall poor health and a higher risk of COPD-related complications.”

For clinicians treating patients with COPD, the researchers underscored the EJI’s impact in identifying factors that could be impacting the health of rural women with COPD. Further, they noted that the community-level factors identified in the study “could be used to develop targeted interventions and care delivery models to address increasing mortality in this population.”