B16-07 Unequal Recovery: Racial Disparities in Pulmonary Rehabilitation and Preventive COPD Care Across the U.S.

Abstract Background Pulmonary rehabilitation (PR) and vaccination are evidence-based interventions that reduce COPD morbidity and mortality. Yet access to these services remains uneven across racial groups. We examined disparities in PR utilization, preventive care, and treatment patterns among Black and White adults with COPD using a national electronic health record network. Methods Adults ≥ 18 years with COPD (ICD-10 J44.x) were identified from the TriNetX US Collaborative Network (72 institutions, 2018-2024). Cohorts (Black n = 447,363; White n = 2,530,537) were 1:1 matched (n = 404,504 each) for age, sex, comorbidities (HTN, DM, CHF, CKD, obesity), smoking status, oxygen use, and ICD-10 Z55-Z65 social risk codes. Outcomes included Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD), Pulmonary rehabilitation, Readmission/ICU encounters, influenza and pneumococcal vaccination, and inhaler therapy (LABA, LAMA, ICS). Comparative analyses were conducted using Kaplan-Meier survival estimates and Cox proportional-hazards models to calculate hazard ratios (HR) with 95% confidence intervals (CI); odds ratios (OR) were reported for categorical outcomes. Results After propensity score matching (n = 404,504 per cohort), baseline characteristics were well balanced (SMD 0.02). Pulmonary rehabilitation (PR) utilization was significantly lower among Black compared with White patients (0.8% vs 1.1%; odds ratio OR 0.72, 95% CI 0.69-0.75; p 0.001). Black patients had a slightly higher risk of AECOPD (26.2% vs 25.5%; hazard ratio HR 1.05, 95% CI 1.05-1.06; p 0.001) and ICU admissions (20.4% vs 19.3%; HR 1.08, 95% CI 1.07-1.09; p 0.001), while rates of hospitalization (48.8% vs 48.7%; p = 0.49), systemic steroid exposure (58.4% vs 58.3%; p = 0.42), and influenza or pneumonia diagnoses (26.2% vs 26.3%; p = 0.29) were similar between groups. Preventive care remained unequal, with vaccination rates markedly lower in Black patients (15.0% vs 17.5%; OR 0.84, 95% CI 0.83-0.85; p 0.001). Ihaler utilization patterns were similar between groups, with comparable rates of LABA (28.8% vs 28.4%), LAMA (28.3% vs 28.1%), and ICS (48.1% vs 46.3%) prescriptions (all p 0.001 but clinically insignificant). Conclusion Black adults with COPD demonstrated lower utilization of pulmonary rehabilitation and preventive vaccination despite comparable comorbidities and inhaler use, highlighting ongoing inequities in evidence-based care. Targeted outreach and equitable referral strategies are needed to improve preventive and rehabilitative access in this population This abstract is funded by: None