Rural-urban disparities in quality of life among patients with COPD.
OBJECTIVE
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, AL 35205, USA. beaj@uab.edu
Bradford E
BE
Jackson
David B
DB
Coultas
Sumihiro
S
Suzuki
Karan P
KP
Singh
Sejong
S
Bae
D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data; D054624:Health Status Disparities; D006801:Humans; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive; D011788:Quality of Life; D012424:Rural Population; D014481:United States; D014505:Urban Population
COPD; health disparities; health-related quality of life; rural; utilization of health services