Rural residence was associated with a higher COPD prevalence than urban areas (10.2% vs 4.9%; unadjusted RR 2.09, 95% CI 1.89-2.59), a disparity completely attenuated after socioeconomic adjustment.
Cross-Sectional (n=40,779)
Yes
Does rural residence increase COPD prevalence compared to urban residence in US adults, and what factors explain this disparity?
Rural-urban disparities in COPD prevalence are primarily driven by socioeconomic factors rather than lifestyle or healthcare access, highlighting the need for targeted public health interventions addressing socioeconomic determinants.
Effect estimate: RR 2.09 (95% CI 1.89-2.59)
Absolute Event Rate: 10.2% vs 4.9%
Abstract Rationale Adults living in rural areas are disproportionately affected by chronic obstructive pulmonary disease (COPD), experiencing higher disease prevalence and greater disease severity compared to their urban counterparts. The degree to which lifestyle, healthcare access, and socioeconomic factors contribute to these differences is unknown, limiting the ability to implement targeted public health interventions. Our aim was to evaluate the extent to which sociodemographic factors are responsible for rural-urban disparities in COPD prevalence. Methods We pooled 2022-2023 data from the National Health Interview Survey, a nationally representative survey conducted by the US Census Bureau that contains detailed information on health conditions and socioeconomic factors. Our study population included US adults age 40 years and older. We first divided the sample into three groups based on rurality - urban, small/medium metropolitan, and rural. Next, we calculated age-standardized rates of COPD for each group and rate ratios (RR) to compare groups using quasibinomial regression models. We then sequentially adjusted for composite groups, specifically demographic factors (age, sex, race and ethnicity), lifestyle (smoking and e-cigarette use), healthcare access (insurance status, doctor’s visit or telehealth visit within last year, usual place of care), and socioeconomic factors (income, education, employment status, income assistance, government-assisted housing) to evaluate the extent to which each category of factors contributes to known rural-urban disparities in COPD prevalence. We repeated our analyses separately among smokers and nonsmokers. Results Our study included 40,779 US adults (mean age 62.5 years, 52.1% female). The age-standardized rate of COPD was higher in rural areas compared to urban areas (10.2% versus 4.9%, unadjusted RR 2.09 95% CI:1.89-2.59) (Table 1). Rural-urban disparities in COPD prevalence remained similar after adjustment for demographic (RR 1.74 95% CI:1.48-2.04), lifestyle (RR 1.61 95% CI:1.37-1.90), and healthcare access factors (RR 1.74 95% CI:1.48-2.05). However, rural-urban disparities in COPD prevalence were completely attenuated after adjustment for socioeconomic factors (RR 1.14 95% CI:0.84-1.53). In subgroup analyses among smokers and nonsmokers, we found similar unadjusted rural-urban disparities with significant attenuation after adjustment for socioeconomic factors, consistent with our primary analysis. Conclusions This national cross-sectional study found significant rural-urban disparities in COPD prevalence, regardless of smoking status. These differences were primarily explained by socioeconomic factors, such as income, education, and employment. Targeted public health interventions addressing socioeconomic factors may help to reduce rural-urban disparities in COPD prevalence. This abstract is funded by: None
Castro et al. (Fri,) conducted a cross-sectional in Chronic obstructive pulmonary disease (COPD) (n=40,779). Rural residence vs. Urban residence was evaluated on Age-standardized rate of COPD (RR 2.09, 95% CI 1.89-2.59). Rural residence was associated with a higher COPD prevalence than urban areas (10.2% vs 4.9%; unadjusted RR 2.09, 95% CI 1.89-2.59), a disparity completely attenuated after socioeconomic adjustment.