B44-27 Rural-Urban Disparities in COPD Exacerbations and Mortality: A Systematic Review

Abstract Rationale Chronic obstructive pulmonary disease (COPD) is a leading cause of global morbidity and mortality. Risk factors at an individual level are well understood, however it remains less clear how these risks translate across different geographical locations. Growing evidence suggests a disparity in COPD outcomes between rural and urban areas, however little data exist on a global scale. This systematic review aimed to consolidate current evidence comparing COPD exacerbations and mortality in rural and urban settings. Methods We conducted a comprehensive search of five databases (Medline, Embase, Emcare, CINAHL, and Cochrane Central) on 7th May 2025 to identify peer-reviewed studies directly comparing rural and urban COPD exacerbations or mortality. Eligible studies clearly defined COPD and directly compared rural and urban differences in COPD exacerbations or mortality. Screening and data extraction were performed, and study quality was assessed using the Newcastle-Ottawa Scale (NOS). Owing to heterogeneity in outcome measures, a narrative synthesis was undertaken. Results Of 2337 records identified, 17 studies met inclusion criteria. The definition of rurality showed significant heterogeneity between studies. Thirteen studies examined exacerbations, with 62% (8/13) conducted in the USA. Data can be split into total exacerbations (n = 5) and those requiring hospitalisations (n = 12). Total exacerbations were higher in rural populations, with 2/5 studies reporting statistical significance (p 0.05). One study demonstrated higher rates rurally without statistical significance, 1/5 studies demonstrated similar rates and 1/5 revealed statistically significant higher rates in urban areas (although this was a deemed a ‘poor’ study on NOS). Hospitalisations varied significantly, with rural odds ratio varying from 0.51 to 1.82 (n = 8). Six of the 12 studies reported higher rates in urban areas (p 0.05 in two studies) and 5/12 studies reporting higher rates in rural areas (p 0.05 in two studies). One study reported the same hospitalisation rates in both rural and urban populations. Seven studies examined mortality, with 71% (5/7) conducted in the USA. Six of the 7 studies demonstrated higher COPD-related mortality in rural areas (figure 1), with 83% (5/6) of these showing statistical significance when adjusting for various co-founders. The single study showing higher mortality in urban areas was the only one examining all-cause mortality and not COPD-related deaths. Conclusions Rural populations experience higher total exacerbation rates and COPD mortality, while urban residents demonstrate higher hospitalisation rates. These findings highlight the impact of healthcare inequities, socioeconomic deprivation, and environmental exposures on COPD outcomes. Targeted interventions are necessary to tackle these inequalities. This abstract is funded by: None