The Effect of Rurality and Poverty on COPD Outcomes in New Hampshire: an Analysis of Statewide Hospital Discharge Data.

Jacob S Warner, Jane M Bryan, L. Paulin
{"title":"The Effect of Rurality and Poverty on COPD Outcomes in New Hampshire: an Analysis of Statewide Hospital Discharge Data.","authors":"Jacob S Warner, Jane M Bryan, L. Paulin","doi":"10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A3030","DOIUrl":null,"url":null,"abstract":"Purpose\nIndividuals in rural areas of the US have greater risk of chronic obstructive pulmonary disease (COPD) and have worse COPD outcomes. New Hampshire (NH) is split between non-rural and rural counties.\n\n\nMethods\nWe examined differences in COPD exacerbation rate ((encounters per county/county population of 35 years of age and older) times 100), length of stay (LOS), and total charges by rurality, determined by 2013 NCHS rural-urban classification. Linear regression analysis determined the association of rural status on COPD outcomes, adjusting for age, gender, insurance status, and county-level smoking prevalence.\n\n\nFindings\n15916 encounters were analyzed, 5805 inpatient and 10111 emergency department, 7058 (44%) male, and mean age 65.6. 31% were from large fringe metro counties, 25.9% from medium metro counties, 37.6% from micropolitan counties and 5.5% from non-core counties. In multivariable regression, rural counties had higher COPD exacerbation rates compared to urban counties; (non-core beta = 0.18, [CI 0.16, 0.20]; micropolitan beta = 0.02, CI [0.01, 0.03]); medium metro (beta = -0.07, Cl [-0.09, -0.06] had lower rates of COPD exacerbations (P < 0.001 for all). Compared to urban counties, encounters from rural counties had lower total charges (medium metro beta = -1695 [-2410, -980]; micropolitan beta = -2701 [-3315, -2088]; non-core beta = -4453 [-5646, -3260], all p<0.001). LOS did not differ by rurality.\n\n\nConclusions\nAccounting for poverty and other sociodemographic factors, the rates of COPD exacerbation encounters were higher in rural vs. non-rural NH counties. Additionally, non-rural areas carried higher total charges, potentially due to more resource availability. These results support the need for future interventions to improve outcomes in rural COPD patients.","PeriodicalId":10249,"journal":{"name":"Chronic obstructive pulmonary diseases","volume":"36 1","pages":""},"PeriodicalIF":0.0000,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"1","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Chronic obstructive pulmonary diseases","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A3030","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 1

Abstract

Purpose Individuals in rural areas of the US have greater risk of chronic obstructive pulmonary disease (COPD) and have worse COPD outcomes. New Hampshire (NH) is split between non-rural and rural counties. Methods We examined differences in COPD exacerbation rate ((encounters per county/county population of 35 years of age and older) times 100), length of stay (LOS), and total charges by rurality, determined by 2013 NCHS rural-urban classification. Linear regression analysis determined the association of rural status on COPD outcomes, adjusting for age, gender, insurance status, and county-level smoking prevalence. Findings 15916 encounters were analyzed, 5805 inpatient and 10111 emergency department, 7058 (44%) male, and mean age 65.6. 31% were from large fringe metro counties, 25.9% from medium metro counties, 37.6% from micropolitan counties and 5.5% from non-core counties. In multivariable regression, rural counties had higher COPD exacerbation rates compared to urban counties; (non-core beta = 0.18, [CI 0.16, 0.20]; micropolitan beta = 0.02, CI [0.01, 0.03]); medium metro (beta = -0.07, Cl [-0.09, -0.06] had lower rates of COPD exacerbations (P < 0.001 for all). Compared to urban counties, encounters from rural counties had lower total charges (medium metro beta = -1695 [-2410, -980]; micropolitan beta = -2701 [-3315, -2088]; non-core beta = -4453 [-5646, -3260], all p<0.001). LOS did not differ by rurality. Conclusions Accounting for poverty and other sociodemographic factors, the rates of COPD exacerbation encounters were higher in rural vs. non-rural NH counties. Additionally, non-rural areas carried higher total charges, potentially due to more resource availability. These results support the need for future interventions to improve outcomes in rural COPD patients.
农村和贫困对新罕布什尔州慢性阻塞性肺病结局的影响:对全州医院出院数据的分析
目的:美国农村地区的个体患慢性阻塞性肺疾病(COPD)的风险更高,COPD的预后也更差。新罕布什尔州(NH)分为非农村县和农村县。方法:根据2013年NCHS城乡分类,我们研究了COPD加重率((每个县/ 35岁及以上的县人口的就诊次数)乘以100)、住院时间(LOS)和总收费的差异。线性回归分析确定了农村状况与COPD结局的关系,调整了年龄、性别、保险状况和县级吸烟率。分析了15916例就诊病例,其中住院5805例,急诊科10111例,男性7058例(44%),平均年龄65.6岁。31%来自大城市边缘县,25.9%来自中等城市县,37.6%来自小城市县,5.5%来自非核心县。在多变量回归中,农村县的COPD加重率高于城市县;(非核心beta = 0.18, [CI 0.16, 0.20];micropolitan beta = 0.02, CI [0.01, 0.03]);中等地铁(β = -0.07, Cl [-0.09, -0.06]) COPD加重率较低(P < 0.001)。与城市县相比,农村县的总收费较低(中等地铁beta = -1695 [-2410, -980];Micropolitan beta = -2701 [-3315, -2088];非核心beta = -4453[-5646, -3260],均p<0.001)。LOS没有因乡村而异。结论:考虑到贫困和其他社会人口因素,农村的慢性阻塞性肺病加重率高于非农村的NH县。此外,非农村地区的总收费较高,这可能是由于更多的可用资源。这些结果支持未来干预措施改善农村COPD患者预后的必要性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
自引率
0.00%
发文量
0
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信