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Association of rural living with COPD-related hospitalizations and deaths in US veterans

It is unclear whether the high burden of COPD in rural areas is related to worse outcomes in patients with COPD or is because the prevalence of COPD is higher in rural areas. We assessed the association of rural living with acute exacerbations of COPD (AECOPDs)-related hospitalization and mortality....

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Autores principales: Fortis, Spyridon, Gao, Yubo, Baldomero, Arianne K., Sarrazin, Mary Vaughan, Kaboli, Peter J.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Nature Publishing Group UK 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10188568/
https://www.ncbi.nlm.nih.gov/pubmed/37193770
http://dx.doi.org/10.1038/s41598-023-34865-7
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author Fortis, Spyridon
Gao, Yubo
Baldomero, Arianne K.
Sarrazin, Mary Vaughan
Kaboli, Peter J.
author_facet Fortis, Spyridon
Gao, Yubo
Baldomero, Arianne K.
Sarrazin, Mary Vaughan
Kaboli, Peter J.
author_sort Fortis, Spyridon
collection PubMed
description It is unclear whether the high burden of COPD in rural areas is related to worse outcomes in patients with COPD or is because the prevalence of COPD is higher in rural areas. We assessed the association of rural living with acute exacerbations of COPD (AECOPDs)-related hospitalization and mortality. We retrospectively analyzed Veterans Affairs (VA) and Medicare data of a nationwide cohort of veterans with COPD aged ≥ 65 years with COPD diagnosis between 2011 and 2014 that had follow-up data until 2017. Patients were categorized based on residential location into urban, rural, and isolated rural. We used generalized linear and Cox proportional hazards models to assess the association of residential location with AECOPD-related hospitalizations and long-term mortality. Of 152,065 patients, 80,162 (52.7%) experienced at least one AECOPD-related hospitalization. After adjusting for demographics and comorbidities, rural living was associated with fewer hospitalizations (relative risk-RR = 0.90; 95% CI: 0.89–0.91; P < 0.001) but isolated rural living was not associated with hospitalizations. Only after accounting for travel time to the closest VA medical center, neighborhood disadvantage, and air quality, isolated rural living was associated with more AECOPD-related hospitalizations (RR = 1.07; 95% CI: 1.05–1.09; P < 0.001). Mortality did not vary between rural and urban living patients. Our findings suggest that other aspects than hospital care may be responsible for the excess of hospitalizations in isolated rural patients like poor access to appropriate outpatient care.
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spelling pubmed-101885682023-05-18 Association of rural living with COPD-related hospitalizations and deaths in US veterans Fortis, Spyridon Gao, Yubo Baldomero, Arianne K. Sarrazin, Mary Vaughan Kaboli, Peter J. Sci Rep Article It is unclear whether the high burden of COPD in rural areas is related to worse outcomes in patients with COPD or is because the prevalence of COPD is higher in rural areas. We assessed the association of rural living with acute exacerbations of COPD (AECOPDs)-related hospitalization and mortality. We retrospectively analyzed Veterans Affairs (VA) and Medicare data of a nationwide cohort of veterans with COPD aged ≥ 65 years with COPD diagnosis between 2011 and 2014 that had follow-up data until 2017. Patients were categorized based on residential location into urban, rural, and isolated rural. We used generalized linear and Cox proportional hazards models to assess the association of residential location with AECOPD-related hospitalizations and long-term mortality. Of 152,065 patients, 80,162 (52.7%) experienced at least one AECOPD-related hospitalization. After adjusting for demographics and comorbidities, rural living was associated with fewer hospitalizations (relative risk-RR = 0.90; 95% CI: 0.89–0.91; P < 0.001) but isolated rural living was not associated with hospitalizations. Only after accounting for travel time to the closest VA medical center, neighborhood disadvantage, and air quality, isolated rural living was associated with more AECOPD-related hospitalizations (RR = 1.07; 95% CI: 1.05–1.09; P < 0.001). Mortality did not vary between rural and urban living patients. Our findings suggest that other aspects than hospital care may be responsible for the excess of hospitalizations in isolated rural patients like poor access to appropriate outpatient care. Nature Publishing Group UK 2023-05-16 /pmc/articles/PMC10188568/ /pubmed/37193770 http://dx.doi.org/10.1038/s41598-023-34865-7 Text en © This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply 2023 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Article
Fortis, Spyridon
Gao, Yubo
Baldomero, Arianne K.
Sarrazin, Mary Vaughan
Kaboli, Peter J.
Association of rural living with COPD-related hospitalizations and deaths in US veterans
title Association of rural living with COPD-related hospitalizations and deaths in US veterans
title_full Association of rural living with COPD-related hospitalizations and deaths in US veterans
title_fullStr Association of rural living with COPD-related hospitalizations and deaths in US veterans
title_full_unstemmed Association of rural living with COPD-related hospitalizations and deaths in US veterans
title_short Association of rural living with COPD-related hospitalizations and deaths in US veterans
title_sort association of rural living with copd-related hospitalizations and deaths in us veterans
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10188568/
https://www.ncbi.nlm.nih.gov/pubmed/37193770
http://dx.doi.org/10.1038/s41598-023-34865-7
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