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

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.