A CDC report shows people living in rural areas experience greater COPD risk, hospitalizations, and mortality. Factors like high rates of smoking, limited access to COPD care, and rural industries may all play a role.
Chronic obstructive pulmonary disease (COPD) is a progressive condition caused by inflammation and damage in your respiratory system.
It includes
- chronic bronchitis, inflammation of your bronchial tubes
- emphysema, damage to the air sacs in your lungs
The inflammation and damage in COPD make breathing difficult, and symptoms such as persistent coughing, wheezing, shortness of breath, and fatigue are common.
While smoking is the leading cause of COPD, other factors — including where you live — can affect your risk of developing this condition.
According to a
The data shows:
- Adults in rural areas (8.2%) experience nearly double the rate of COPD compared to those in urban areas (4.8%).
- Hospitalizations for COPD in rural areas were about
14 per 1,000 , compared to hospitalizations in urban areas of about 11 per 1,000. - Mortality rates from COPD in rural areas were about
55 per 100,000 people , compared to 32 per 100,000 people in large metropolitan areas.
What makes an area rural?
In the United States, the Census Bureau defines a rural area as any area not meeting the population and housing density requirements to be considered urban. Areas that qualify as urban must contain at least 2,000 housing units or have a population density of at least 5,000.
In research, the definition of urban and rural can vary, and the recent CDC report defined urban counties as those with populations of at least
Medical disparities occur in different populations for several reasons. Lifestyle habits, local culture, income and education level, environmental exposures, and access to healthcare are just a few examples of factors that can alter wellness outcomes.
When it comes to COPD, Dr. Steven Davis, a pulmonologist and Associate Professor of Internal Medicine at Burnett School of Medicine at Texas Christian University (TCU) in Forth Worth, TX, explains one of the major factors is the prevalence of smoking.
“While there are exceptions, COPD is a disease of smoking, and smoking is more prevalent in rural areas,” he said. “Further, there is less opportunity for smoking cessation efforts in rural areas, both in terms of the programs themselves or the clinicians to make the referral to them.”
According to current statistics, adults living in rural areas have a smoking rate of 15.4% compared to 10.1% of those in urban areas.
Local culture and industry also matter. States with prominent tobacco industries, like Alabama, Arkansas, and Indiana, have smoking rates over 40% higher than other states. These states are among those in the
Barriers to medical care like transportation, access to COPD specialists, and affordability may influence the increase in COPD hospitalizations and mortality in rural areas.
“Unlike more urban settings, a trip to a healthcare [professional] may require a significantly long travel time,” Davis said. “Further, access to specialists is much more limited in rural settings, further limiting care. Programs like pulmonary rehab — that has been shown to improve quality of life — are typically done through hospitals or rehab centers, and these too may not be available in rural areas.”
When it’s not convenient or affordable to visit the doctor, many people delay having symptoms checked until they become severe. At that point, COPD may be significantly advanced, increasing the likelihood a person will need hospitalization or more intensive treatments.
The CDC encourages people with COPD to take the following necessary steps to help improve COPD outcomes:
- stopping smoking
- being physically active
- getting vaccines for major respiratory illnesses like the flu
- discussing pulmonary rehabilitation with a doctor
While stopping smoking is the main goal in reducing COPD disparities in rural areas, other changes at the systemic level are important. This includes initiatives to increase access to healthcare and COPD specialists, such as:
- transportation support
- affordable healthcare choices
- culturally relevant care
- increasing public education about smoking cessation programs
Davis explained: “Stopping smoking is the simplest answer, though would take the longest to have an impact. Encouraging funding access to rural healthcare at the state and federal levels is important. Patients telling their own stories about difficulty accessing care are powerful for lawmakers to hear.”
COPD is considered largely preventable, and if you’ve received a COPD diagnosis, treatment and lifestyle changes can help reduce persistent inflammation, damage to your airways, and how quickly the condition progresses.
If you live in a rural area and access to care is limited, you can still reach out to COPD experts:
- connect with the American Lung Association’s (ALA) Lung Health Navigators
- call the ALA’s Lung Helpline at 1-800-586-4872
Rural communities face disparities in COPD risk, hospitalizations, and mortality rates. High rates of smoking, local industry culture, and limited access to COPD medical care are all factors that may contribute to these disparities.
While stopping smoking is the best way an individual can help reduce their risk for COPD and COPD-related complications, reducing the disparity in rural areas may require broader changes at the local and federal government levels.