Factors contributing to COPD hospitalisations from 2010 to 2015: Variation among rural and metropolitan Australians

Abstract

Introduction Rural and remote populations experience the greatest burden of chronic obstructive pulmonary disease (COPD), the fifth leading cause of death in Australia. Currently there is a need to prioritise health services to improve health outcomes among those at higher risk of COPD. Objectives To investigate the differences in COPD hospitalisation between rural and urban populations and determine predictive factors contributing to COPD hospitalisation. Methods Statewide hospitalisation data from 2010 to 2015 were obtained through the Victorian Admitted Episodes Dataset and other key data sets. The rates of hospitalisation were analysed using hierarchical multiple regression to examine the association between COPD hospitalisations and a number of predictor variables. Results The highest COPD incidence occurred in metropolitan males aged 85 years of age and older (35.092 hospitalisations per 1000 population). Among metropolitan residents, smoking, population density and household income had a significant association with COPD hospitalisations for both sexes. Among rural males, smoking rates, household income and rural land use (farming) were significant predictors of COPD hospitalisations. There was an overall stability in statewide COPD hospitalisation over the 5 years to 2015, P = 0.420. Conclusion This investigation highlights many rural and regional areas have much lower COPD hospitalisation rates than metropolitan areas. Between males and females, there are heterogenetic factors that contribute to the significant variation associated with COPD hospitalisation in metropolitan and rural areas, such as rural land use among rural males. This indicates that risk factor assessments, beyond smoking alone, need to be individualised and prioritised in practice to optimise care.

Does distance to hospital affect emergency department presentations and hospital length of stay among chronic obstructive pulmonary disease patients?

“…Past studies have indicated that due to unavailability of primary and specialist care in rural areas, care for COPD (particularly among the most socioeconomically disadvantaged patients) occurs in EDs 11 as well as distance to hospitals has no relationship with early discharge from hospital (Agboado) 20 . However, several distance-specific studies have concluded that lower utilisation of hospital care is associated with distance to hospital (Terry et al 5 , Zielinsk et al 15 , LaVela 16 and Escarce et al 17 ). One possible explanation of the findings in this study could be the mean age difference between the short and intermediate distance patients with long-distance patients.…”

“…The primary care management of COPD patients includes a range of options for patient monitoring to identify changes in symptoms, reduce risk of acute exacerbations, improve patient compliance with prescribed treatment/s, increase participation in non-traditional pulmonary rehabilitation clinics, and to more effectively support patients to adopt healthier lifestyle behaviours (e.g. smoking cessation) 4,5 . Thus, the primary goal is to optimize a patient's functional status and quality of life by preserving best possible lung function, improving symptoms management, and avoiding the recurrence of exacerbations.…”

“…comorbidities) and health behaviours (e.g. smoking) as well as frequency of hospital admissions among COPD patients 5,10,11 . Other studies have examined the impact of remoteness on hospital admission among ambulatory care sensitive chronic conditions such as COPD however, these findings are inconsistent.…”

The Geographical Distribution of Morbidity Caused By Chronic Obstructive Pulmonary Disease in Turkey: COPDTURKEY-2

“…They are also the reasons behind the preference of the patients being hospitalized, rather than being outpatients. Thus, in Australia, in many studies that were done in order to evaluate the difference in hospitalization rates between the rural populations and city populations, it was found that in the rural areas, there were less hospitalized COPD patients (26). It is thought that the reason why the diagnosis frequency of COPD is high is because of the Black Sea Region has the highest rate of the population over the age of 65, which is 12.8% (15).…”

Association Between Rural Residence and In-Hospital and 30-Day Mortality Among Veterans Hospitalized with COPD Exacerbations

“…Environmental factors have been implicated as potential causes of observed rural-urban disparities, with agriculture-related exposure being associated with COPD exacerbations. 12,36 However, European studies suggest that agriculture exposure may be protective. 37,38 Higher prevalence of comorbidities in rural patients may also be responsible for rural-urban disparities in COPD.…”