Rural residence and chronic obstructive pulmonary disease exacerbations

Analysis of the SPIROMICS cohort

SPIROMICS investigators

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)808-815
Number of pages8
JournalAnnals of the American Thoracic Society
Volume15
Issue number7
DOIs
StatePublished - Jul 1 2018

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Chronic Obstructive Pulmonary Disease
Disease Progression
Cohort Studies
Outcome Assessment (Health Care)
Incidence
Geographic Mapping
Occupations
Confidence Intervals
Odds Ratio
Time and Motion Studies
Vital Capacity
Forced Expiratory Volume
Rural Population
Occupational Exposure
Ambulatory Care
Agriculture
Telephone
Hospitalization
Chronic Disease
Steroids

Keywords

  • Chronic obstructive pulmonary disease
  • Exacerbation
  • Rural health

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Rural residence and chronic obstructive pulmonary disease exacerbations : Analysis of the SPIROMICS cohort. / SPIROMICS investigators.

In: Annals of the American Thoracic Society, Vol. 15, No. 7, 01.07.2018, p. 808-815.

Research output: Contribution to journalArticle

@article{54bdcf6c84e14209b55e9a716fed26ec,
title = "Rural residence and chronic obstructive pulmonary disease exacerbations: Analysis of the SPIROMICS cohort",
abstract = "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.",
keywords = "Chronic obstructive pulmonary disease, Exacerbation, Rural health",
author = "{SPIROMICS investigators} and Burkes, {Robert M.} and Gassett, {Amanda J.} and Ceppe, {Agathe S.} and Wayne Anderson and O'Neal, {Wanda K.} and Woodruff, {Prescott G.} and Krishnan, {Jerry A.} and Barr, {R. Graham} and Han, {Mei Lan K.} and Martinez, {Fernando J.} and Comellas, {Alejandro P.} and Lambert, {Allison A.} and Kaufman, {Joel D.} and Dransfield, {Mark T.} and Wells, {J. Michael} and Kanner, {Richard E.} and Robert Paine and Bleecker, {Eugene R.} and Paulin, {Laura M.} and Nadia Hansel and Drummond, {M. Bradley} and Alexis, {Neil E.} and Anderson, {Wayne H.} and Boucher, {Richard C.} and Bowler, {Russell P.} and Carretta, {Elizabeth E.} and Christenson, {Stephanie A.} and Cooper, {Christopher B.} and Couper, {David J.} and Criner, {Gerard J.} and Crystal, {Ronald G.} and Curtis, {Jeffrey L.} and Doerschuk, {Claire M.} and Freeman, {Christine M.} and Hastie, {Annette T.} and Hoffman, {Eric A.} and Kleerup, {Eric C.} and LaVange, {Lisa M.} and Lazarus, {Stephen C.} and Meyers, {Deborah A.} and Moore, {Wendy C.} and Newell, {John D.} and Stephen Peters and Oelsner, {Elizabeth C.} and Ortega, {Victor E.} and Nirupama Putcha and Rennard, {Stephen I.} and Tashkin, {Donald P.} and Scholand, {Mary Beth} and Wise, {Robert A}",
year = "2018",
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day = "1",
doi = "10.1513/AnnalsATS.201710-837OC",
language = "English (US)",
volume = "15",
pages = "808--815",
journal = "Annals of the American Thoracic Society",
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TY - JOUR

T1 - Rural residence and chronic obstructive pulmonary disease exacerbations

T2 - Analysis of the SPIROMICS cohort

AU - SPIROMICS investigators

AU - Burkes, Robert M.

AU - Gassett, Amanda J.

AU - Ceppe, Agathe S.

AU - Anderson, Wayne

AU - O'Neal, Wanda K.

AU - Woodruff, Prescott G.

AU - Krishnan, Jerry A.

AU - Barr, R. Graham

AU - Han, Mei Lan K.

AU - Martinez, Fernando J.

AU - Comellas, Alejandro P.

AU - Lambert, Allison A.

AU - Kaufman, Joel D.

AU - Dransfield, Mark T.

AU - Wells, J. Michael

AU - Kanner, Richard E.

AU - Paine, Robert

AU - Bleecker, Eugene R.

AU - Paulin, Laura M.

AU - Hansel, Nadia

AU - Drummond, M. Bradley

AU - Alexis, Neil E.

AU - Anderson, Wayne H.

AU - Boucher, Richard C.

AU - Bowler, Russell P.

AU - Carretta, Elizabeth E.

AU - Christenson, Stephanie A.

AU - Cooper, Christopher B.

AU - Couper, David J.

AU - Criner, Gerard J.

AU - Crystal, Ronald G.

AU - Curtis, Jeffrey L.

AU - Doerschuk, Claire M.

AU - Freeman, Christine M.

AU - Hastie, Annette T.

AU - Hoffman, Eric A.

AU - Kleerup, Eric C.

AU - LaVange, Lisa M.

AU - Lazarus, Stephen C.

AU - Meyers, Deborah A.

AU - Moore, Wendy C.

AU - Newell, John D.

AU - Peters, Stephen

AU - Oelsner, Elizabeth C.

AU - Ortega, Victor E.

AU - Putcha, Nirupama

AU - Rennard, Stephen I.

AU - Tashkin, Donald P.

AU - Scholand, Mary Beth

AU - Wise, Robert A

PY - 2018/7/1

Y1 - 2018/7/1

N2 - 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.

AB - 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.

KW - Chronic obstructive pulmonary disease

KW - Exacerbation

KW - Rural health

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U2 - 10.1513/AnnalsATS.201710-837OC

DO - 10.1513/AnnalsATS.201710-837OC

M3 - Article

VL - 15

SP - 808

EP - 815

JO - Annals of the American Thoracic Society

JF - Annals of the American Thoracic Society

SN - 2325-6621

IS - 7

ER -