Urban-Rural Differences in COPD

Chronic obstructive pulmonary disease (COPD) is a group of respiratory conditions, including chronic bronchitis and emphysema, that makes breathing difficult for millions of Americans. COPD comprises the majority of deaths from chronic lower respiratory diseases, which was the fourth leading cause of death in the United States in 2016. Learn how COPD diagnosis, Medicare hospitalizations, and deaths vary from urban to rural areas.

The percentage of adults in rural areas who have been diagnosed with COPD is nearly double the percentage in large metropolitan areas, according to data released in CDC’s Morbidity and Mortality Weekly Report (MMWR).1 The study reported in MMWR examined how many people have COPD in urban and rural areas using data from the 2015 Behavioral Risk Factor Surveillance System (BRFSS). CDC also examined Medicare hospital records and death certificate data from the National Vital Statistics System. In 2015, rural US residents experienced higher rates of Medicare-covered hospitalizations for and deaths from COPD than residents living in more urban areas (those with populations of at least 10,000 people).

Percentage with diagnosed COPD was greater among adults living in rural areas (about 8%) than among adults living in large metropolitan centers (about 5%).
Hospitalizations among Medicare enrollees were about 14 per 1000 enrollees in rural areas compared with about 11 per 1000 enrollees in large metropolitan centers.
Death rates from COPD were also greater among people living in rural areas (about 55 per 100,000 people) versus people living in large metropolitan centers (32 per 100,000 people).

Seven states–Alabama, Arkansas, Indiana, Kentucky, Mississippi, Tennessee, and West Virginia–had the highest estimates for COPD diagnosis, hospitalizations among Medicare enrollees, and death. Arkansas, Kentucky, Mississippi, and West Virginia had the highest percentage of rural populations.

Map: Unadjusted prevalence of doctor-diagnosed COPD among adults aged greater than 18 years, by county - United States, 2015

County-level estimates of COPD prevalence in 2015 ranged from 3.2% to 15.6%. The US counties with the highest COPD prevalence tended to be located in non-metropolitan areas of West Virginia, Kentucky, Tennessee, Alabama, Arkansas, Georgia, Missouri, Ohio, Maine, Michigan, Oklahoma, and Arizona.

Rural populations may have more COPD-related issues due to more people smoking,2 increased exposure to secondhand smoke, and less access to smoking cessation programs compared with people living in more urban areas.3 Rural residents are also more likely to be uninsured and have higher poverty levels, which may lead to less access to early diagnosis and treatment.4

Additional efforts are needed to prevent and reduce risk factors and overcome barriers to early diagnosis and appropriate treatment and management of COPD in rural areas. Improving access to such health care may improve quality of life and reduce hospital readmissions among COPD patients and reduce COPD-related deaths. This study highlights the need for continued tobacco cessation programs and policies to prevent COPD and improve pulmonary function among adults with COPD in rural areas in particular. The findings also highlight the need for more widespread treatment, including pulmonary rehabilitation and oxygen therapy, and comprehensive chronic disease-self-management programs.

Health care providers and community partners that serve rural residents can help adults with COPD increase access to and participation in these health care interventions.