Rural Residence and Chronic Obstructive Pulmonary Disease Exacerbations Analysis of the SPIROMICS Cohort

被引：33

作者：

Burkes, Robert M. ^{[1
]}

Gassett, Amanda J. ^{[3
]}

Ceppe, Agathe S. ^{[2
]}

Anderson, Wayne ^{[2
]}

O'Neal, Wanda K. ^{[2
]}

Woodruff, Prescott G. ^{[5
,6
]}

Krishnan, Jerry A. ^{[7
]}

Barr, R. Graham ^{[8
]}

Han, MeiLan K. ^{[9
]}

Martinez, Fernando J. ^{[10
]}

Comellas, Alejandro P. ^{[11
]}

Lambert, Allison A. ^{[4
]}

Kaufman, Joel D. ^{[3
]}

Dransfield, Mark T. ^{[12
]}

Wells, J. Michael ^{[12
]}

Kanner, Richard E. ^{[13
]}

Paine, Robert, III ^{[13
]}

Bleecker, Eugene R. ^{[14
]}

Paulin, Laura M. ^{[15
]}

Hansel, Nadia N. ^{[15
]}

Drummond, M. Bradley ^{[1
]}

机构：

[1] Univ North Carolina Chapel Hill, Dept Med, Cyst Fibrosis Res Ctr, Div Pulm Dis & Crit Med, Chapel Hill, NC USA

[2] Univ North Carolina Chapel Hill, Dept Med, Cyst Fibrosis Res Ctr, Marsico Lung Inst, Chapel Hill, NC USA

[3] Univ Washington, Sch Publ Hlth, Dept Environm & Occupat Hlth Sci, Seattle, WA 98195 USA

[4] Univ Washington, Div Pulm & Crit Care, Seattle, WA 98195 USA

[5] Univ Calif San Francisco, Sch Med, Dept Med, Div Pulm Crit Care Sleep & Allergy, San Francisco, CA USA

[6] Univ Calif San Francisco, Sch Med, Cardiovasc Res Inst, San Francisco, CA USA

[7] Univ Illinois, Div Pulm Crit Care Sleep & Allergy, Chicago, IL USA

[8] Columbia Univ, Dept Med, Med Ctr, New York, NY USA

[9] Univ Michigan Hlth Syst, Div Pulm & Crit Care Med, Ann Arbor, MI USA

[10] New York Presbyterian Hosp, Weill Cornell Med Ctr, Weill Cornell Med Coll, Dept Med, New York, NY USA

[11] Univ Iowa, Div Pulm & Crit Care, Iowa City, IA USA

[12] Univ Alabama Birmingham, Div Pulm & Crit Care, Birmingham, AL USA

[13] Univ Utah, Dept Internal Med, Div Pulm & Crit Care Med, Salt Lake City, UT 84112 USA

[14] Wake Forest Univ, Div Pulm Crit Care Allergy & Immunol Dis, Winston Salem, NC 27109 USA

[15] Johns Hopkins Sch Med, Dept Med, Div Pulm & Crit Care Med, Baltimore, MD USA

来源：

ANNALS OF THE AMERICAN THORACIC SOCIETY | 2018年 / 15卷 / 07期

基金：

美国国家卫生研究院;

关键词：

chronic obstructive pulmonary disease; exacerbation; rural health; AIR-FLOW OBSTRUCTION; COPD EXACERBATIONS; UNITED-STATES; COMPUTED-TOMOGRAPHY; RISK; HEALTH; URBAN; DISPARITIES; PREVALENCE; MORTALITY;

D O I：

10.1513/AnnalsATS.201710-837OC

中图分类号：

R56 [呼吸系及胸部疾病];

学科分类号：

摘要：

Rationale: Rural residence is associated with poor outcomes in several chronic diseases. The association between rural residence and chronic obstructive pulmonary disease (COPD) exacerbations remains unclear. Objectives: In this work, we sought to determine the independent association between rural residence and COPD-related outcomes, including COPD exacerbations, airflow obstruction, and symptom burden. Methods: A total of 1,684 SPIROMICS (Subpopulations and Intermediate Outcome Measures in COPD Study) participants with forced expiratory volume in 1 second/forced vital capacity, 0.70 had geocoding-defined rural-urban residence status determined (N = 204 rural and N = 1,480 urban). Univariate and multivariate logistic and negative binomial regressions were performed to assess the independent association between rurality and COPD outcomes, including exacerbations, lung function, and symptom burden. The primary exposure of interest was rural residence, determined by geocoding of the home address to the block level at the time of study enrollment. Additional covariates of interest included demographic and clinical characteristics, occupation, and occupational exposures. The primary outcome measures were exacerbations determined over a 1-year course after enrollment by quarterly telephone calls and at an annual research clinic visit. The odds ratio (OR) and incidence rate ratio (IRR) of exacerbations that required treatment with medications, including steroids or antibiotics (total exacerbations), and exacerbations leading to hospitalization (severe exacerbations) were determined after adjusting for relevant covariates. Results: Rural residence was independently associated with a 70% increase in the odds of total exacerbations (OR, 1.70 [95% confidence interval (CI), 1.13-2.56]; P = 0.012) and a 46% higher incidence rate of total exacerbations (IRR 1.46 [95% CI, 1.02-2.10]; P = 0.039). There was no association between rural residence and severe exacerbations. Agricultural occupation was independently associated with increased odds and incidence of total and severe exacerbations. Inclusion of agricultural occupation in the analysis attenuated the association between rural residence and the odds and incidence rate of total exacerbations (OR, 1.52 [95% CI, 1.00-2.32]; P = 0.05 and IRR 1.39 [95% CI, 0.97-1.99]; P = 0.07). There was no difference in symptoms or airflow obstruction between rural and urban participants. Conclusions: Rural residence is independently associated with increased odds and incidence of total, but not severe, COPD exacerbations. These associations are not fully explained by agriculture-related exposures, highlighting the need for future research into potential mechanisms of the increased risk of COPD exacerbations in the rural population.

引用

页码：808 / 816

页数：9