ARTICLE: Rural Residence and Poverty are Independent Risk Factors for COPD in the United States

AUTHORS: Sarath Raju, Corinne A Keet, Laura M Paulin, Elizabeth C Matsui, Roger D Peng, Nadia N Hansel and Meredith C McCormack

JOURNAL: Am J Respir Crit Care Med. 2018 Nov 2. doi: 10.1164/rccm.201807-1374OC. [Epub ahead of print]


RATIONALE: In developing countries, poor and rural areas have a high burden of Chronic Obstructive Pulmonary Disease(COPD), with environmental pollutants and the indoor burning of biomass implicated as potential causal exposures. Less is known about the prevalence of COPD in the United States with respect to urban-rural distribution, poverty, and factors that uniquely contribute to COPD amongst never-smokers.

OBJECTIVES: To understand the impact of urban-rural status, poverty and other community factors on COPD prevalence nationwide and amongst never-smokers.

METHODS: We studied a nationally representative sample of adults in the National Health Interview Survey(NHIS) 2012-2015, with data linkage between neighborhood data from the U.S. Census's American Community Survey and the National Center for Health Statistics Urban-Rural Classification Scheme. The main outcome was COPD prevalence.

MEASUREMENTS AND MAIN RESULTS: The prevalence of COPD in poor, rural areas was almost twice that of the overall population(15.4% versus 8.4%). In adjusted models, rural residence(Odds Ratio(OR), 1.23; p<0.001) and census level poverty(OR, 1.12; p=0.012) were both associated with COPD prevalence, as were indicators of household wealth. Among never-smokers, rural residence was also associated with COPD(OR, 1.34; p<0.001), as was neighborhood use of coal for heating(OR, 1.09; p<0.001).

CONCLUSIONS: In a nationally representative sample, rural residence and poverty were risk factors for COPD, even amongst never-smokers. The use of coal for heating was also a risk factor for COPD among never-smokers. Future disparities research to better understand contributors to COPD development in poor and rural areas, including assessment of heating sources and environmental pollutants, is needed.

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