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Increased Mortality for Isolated Rural Patients With COPD

Patients living in isolated rural areas have higher COPD-exacerbated 30-day mortality

TUESDAY, July 19 (HealthDay News) -- Patients with chronic obstructive pulmonary disease (COPD) living in isolated rural areas have increased mortality from COPD exacerbations compared to those living in urban areas, according to a study published in the July 19 issue of the Annals of Internal Medicine.

Thad E. Abrams, M.D., from the Iowa City Veterans Affairs Medical Center, and colleagues investigated whether COPD-related mortality is higher in individuals living in rural areas, and they evaluated whether hospital characteristics influence these correlations. Data were collected from 26,591 hospitalized patients with COPD exacerbation from 129 Veterans Affairs hospitals. The primary outcome measured was 30-day mortality. Primary and secondary exposures measured were patient rurality, hospital volume, and hospital rurality, which was defined as the average proportion of hospital admissions coming from rural areas.

The investigators found that 71 percent of the study population lived in urban areas, 21 percent in rural areas, and 7 percent in isolated rural areas. Mortality was significantly elevated in patients living in isolated rural areas compared with those living in urban areas (5 versus 3.8 percent). This association persisted after adjusting for patient characteristics, hospital rurality, and hospital volume (odds ratio, 1.42). Patients living in nonisolated rural areas did not seem to have increased adjusted mortality. The results were not changed in analyses that assessed the influence of an omitted confounder.

"Patients from isolated rural areas admitted for a COPD exacerbation have an increased risk for 30-day mortality independent of the characteristics of the admitting hospitals," the author writes.

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