Urban-rural differences in health status among patients with chronic obstructive pulmonary disease (COPD)

Background: While geographic variation in health care access and quality may affect health status of patients with chronic diseases little is known about the health status of patients with COPD. Objectives: The purpose of this analysis was to examine urban-rural differences in health status among patients with COPD. Methods: This was a cross-sectional analysis of baseline data from patients with COPD enrolled in a self-management clinical trial. Urban-rural residence was determined from zip code. Health status was measured using BODE index (BMI, obstructive impairment, dyspnea severity, exercise capacity), and generic (SF-12) and disease-specific (Chronic Respiratory Questionnaire [CRQ]) quality-of-life instruments. Independent sample t-tests and chi-square tests were used to examine statistical differences. Results: To date, results from 82 patients are available with mean age of 69 years, 46% female, 51% rural residence, and 98.8% with health insurance. Rural residence was associated with greater impairment (mean [SD] BODE index=4.9 [1.8]) compared to urban residence (3.4 [1.8], p=0.0003). Moreover, 6-minute walk distance was clinically and significantly less among rural (325 m [104]) vs. urban (375 m [90]) (p=0.02) residence. A similar pattern was found for quality-of-life measures with a lower SF-12 physical summary score among rural (28.3 [9.6]) vs. urban (36.1 [10.0], p=0.0006) residence and clinically worse dyspnea (CRQ-dyspnea=4.1 [1.0]) vs. 4.8 [1.3], respectively, p=0.009). Conclusion: In this population of patients with COPD rural residence was associated with poorer health status for all measures despite similar access to health care as measured by health insurance.