Rural women with COPD face greater social, health vulnerabilities
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Key takeaways:
- Mortality rates have been increasing for rural women with COPD.
- Rural women with COPD have more asthma, hypertension, cancer and diabetes.
- Identification of these factors may lead to more targeted care.
BOSTON — Women with COPD who live in rural areas have poorer Environmental Justice Index scores indicating disparities than those who live in urban areas, according to a study presented at the CHEST Annual Meeting.
These women had particularly low scores pertaining to social and health vulnerability in the index, Arianne K. Baldomero, MD, assistant professor, pulmonary, allergy, critical care and sleep medicine, University of Minnesota Medical School, and colleagues wrote.
The study was driven by findings published by the CDC Morbidity and Mortality Weekly Report indicating rising mortality rates for rural women with COPD between 1999 and 2019, which contrasts with declining mortality rates among men and urban women, Baldomero told Healio.
“The increasing mortality among rural women remains poorly understood, prompting researchers to investigate whether environmental, social and health disparities contribute to these geographic differences,” she said. “We hypothesized that these factors might explain the worsening outcomes for rural women with COPD.”
Study design, results
The retrospective analysis included 50,042 women with COPD, defined as two or more ICD codes for COPD between 2016 and 2019.
The cohort included 67% who lived in urban areas and 33% who lived in rural areas, based on Rural-Urban Commuting Area codes. The researchers assessed the differences between these groups based on the Environmental Justice Index, which surveys 36 environmental, social and health factors based on each census tract.
Environmental Justice Index scores included 55.8 ± 25.8 for rural women and 52.9 ± 29 for urban women (P < .001), indicating a greater burden among rural women.
Social Vulnerability module scores included 58.2 ± 22.8 for rural women and 55 ± 27.1 for urban women (P < .001), also indicating a greater burden among rural women.
Similarly, Health Vulnerability module scores included 50.2 ± 32.2 for rural women and 33.5 ± 30.6 for urban women (P < .001), indicating a greater burden among rural women as well.
Specific differences between rural and urban women in the Social Vulnerability module included scores of 58.8 ± 21.2 vs. 54.4 ± 26.7 for living in areas with higher poverty; 56.1 ± 24.6 vs. 55.6 ± 26.9 for more uninsured; 65.5 ± 22 vs. 48.7 ± 49.2 for less internet access; and 76.9 ± 22.8 vs. 40.2 ± 35.5 for more mobile homes (P < .001 for all).
In the Health Vulnerability module, specific differences between rural and urban women included scores of 43.1 ± 49.5 vs. 34.2 ± 47.5 for COPD related to asthma; 60.2 ± 49 vs. 36.7 ± 48.2 for hypertension; 51.1 ± 50.5 vs. 25.9 ± 43.8 for cancer; 50.1 ± 50 vs. 33.7 ± 47.3 for diabetes; and 46.5 ± 50 vs. 36.8 ± 48.2 for mental health (P < .001 for all).
Conclusions, next steps
The researchers said that women with COPD who live in rural areas face disparities in access to health care that likely are associated with overall poor health and higher risks for complications related to COPD.
“Rural women with COPD also lived in areas with significantly higher rates of asthma, hypertension, cancer, diabetes and mental health issues compared to their urban counterparts,” Baldomero said. “These comorbidities likely compound the challenges they face in managing COPD.”
However, the researchers continued, these factors that the Environmental Justice Index identified may contribute to these disparities and could be used in the development of targeted interventions and models of care delivery that would address the increasing mortality rates in this group of patients.
“Doctors can use the Environmental Justice Index to identify rural women who live in areas with higher social and health burdens, enabling proactive identification of patients at risk for missing appointments or struggling to afford medications and therapies,” Baldomero said.
Also, she continued, these women may benefit from social work services, and the consolidation of medical appointments may reduce logistical challenges as well.
Policymakers can also help improve outcomes, Baldomero said.
“Policymakers can focus on improving health care infrastructure in rural areas by expanding broadband access for telemedicine, increasing health care provider availability and enhancing insurance coverage,” she said.
“Addressing social determinants, such as improving education and economic opportunities, would also help alleviate the broader social vulnerabilities these patients face,” she said.
Next, research may compare mortality, COPD exacerbations, health care utilization and other outcomes among rural and urban women with COPD, Baldomero said.
“Additionally, it will be important to assess the receipt and provision of health care services, including guideline-based COPD care, to understand how these factors contribute to disparities,” she said.
However, Baldomero noted that the Environmental Justice Index measures community-level factors, which may not always correlate with individual factors.
“Assessing how well these community-level indicators align with individual-level characteristics will be crucial in determining whether the [Environmental Justice Index] can serve as a reliable surrogate for individual-level factors,” she said.
Baldomero said future research should concentrate on developing and testing targeted interventions that can address these disparities.
“Multidisciplinary services could be designed to proactively identify rural women at risk of missing care, ensuring they receive timely interventions,” she said. “These patients may benefit from integrated care models that address their unique needs and improve health outcomes.”
For more information:
Arianne K. Baldomero, MD, can be reached at baldo004@umn.edu.
Perspective
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Gerard J. Criner, MD, FACP, FACCP
These findings are significant and shed light on an understudied problem — women who suffer from COPD and lack of access to appropriate health care because of poverty, higher education, poor internet access and higher rates of comorbid conditions.
To mitigate these disparities, doctors can provide better education to these patients about their disease, use telemedicine for patient care and lobby for greater access despite their rural location. On a policy level, we also can strive to rectify these social issues — poverty, internet access, health care access, education and home dwellings.
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