Urban-Rural County and State Differences in Chronic Obstructive Pulmonary Disease — United States, 2015

Croft, Janet B.; Wheaton, Anne G.; Liu, Yong; Xü, Fang; Lu, Hua; Matthews, Kevin; Cunningham, Timothy J.; Wang, Yan; Holt, James B.

doi:10.15585/mmwr.mm6707a1

Cited by 166 publications

(129 citation statements)

References 6 publications

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“…40,41 Although our study examined the association between potentially modifiable area-level socioeconomic and health-care delivery factors and county-level receipt of surgery, there may be contributory factors not considered in this analysis that vary across counties. One such factor in county-level variation is prevalence of comorbid conditions, 42,43 which may have affected receipt of surgery across counties. Although previous studies reported county-level variations in prevalence of comorbid conditions, other studies showed that most patients with lung cancer and with comorbid conditions chestjournal.org receive surgery, and accounting for differences in statelevel COPD prevalence did not change state-level variations in receipt of surgery for patients with earlystage lung cancer.…”

Section: Discussionmentioning

confidence: 99%

County-Level Variations in Receipt of Surgery for Early-Stage Non-small Cell Lung Cancer in the United States

Sineshaw

Sahar

Osarogiagbon

et al. 2020

Chest

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BACKGROUND: Although counties are the smallest geographic level for comprehensive healthcare delivery analysis, little is known about county-level variations in receipt of curativeintent surgery for early-stage non-small cell lung cancer (NSCLC) and factors contributing to such variations in the United States.METHODS: A total of 179,189 patients aged $ 35 years who were diagnosed with stage I to II NSCLC between 2007 and 2014 in 2,263 counties were identified from 39 states, the District of Columbia, and Detroit population-based cancer registries; the data were compiled by the North American Association of Central Cancer Registries. The percentage of patients who underwent surgery was calculated for each county with $ 20 cases. Adjusted risk ratios were generated by using generalized estimating equation models with modified Poisson regression.RESULTS: Receipt of surgery for early-stage NSCLC during 2007 to 2014 according to county ranged from 12.8% to 48.6% in the lowest decile of counties, to 74.3% to 91.7% in the highest decile of counties. There were pockets of low surgery receipt rate counties within each state. For example, there was a 25% absolute difference between the lowest and highest surgery receipt rate counties in Massachusetts. Counties in the lowest quartile for receipt of surgery were those with a high proportion of non-Hispanic black subjects, high poverty and uninsured rates, low surgeon-to-population ratio, and nonmetropolitan status.CONCLUSIONS: Receipt of curative-intent surgery for early-stage NSCLC varied substantially across counties in the United States, with pockets of low receipt counties in each state. Low surgery receipt counties were characterized by unfavorable area-level socioeconomic and health-care delivery factors. CHEST 2020; 157(1):212-222

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Section: Discussionmentioning

confidence: 99%

County-Level Variations in Receipt of Surgery for Early-Stage Non-small Cell Lung Cancer in the United States

Sineshaw

Sahar

Osarogiagbon

et al. 2020

Chest

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“…Chronic obstructive pulmonary disease (COPD) is a complex lung disease characterized by airways inflammation and lung tissue remodeling, leading to loss of small airways and emphysema . It is the fourth leading cause of death in the United States, responsible for more than 150,000 deaths yearly . More than 15 million people have been diagnosed with COPD and, compared to 4.7% in large metropolitan areas, a staggering 8.2% of those living in rural areas have the disease .…”

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confidence: 99%

“…More than 15 million people have been diagnosed with COPD and, compared to 4.7% in large metropolitan areas, a staggering 8.2% of those living in rural areas have the disease . That translates to about 3.5 million people, and it does not include the estimated additional 1 million undiagnosed . Notably, even among never‐smokers, rural residence and poverty are risk factors for COPD .…”

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confidence: 99%

“…1 It is the fourth leading cause of death in the United States, responsible for more than 150,000 deaths yearly. 2 More than 15 million people have been diagnosed with COPD and, compared to 4.7% in large metropolitan areas, a staggering 8.2% of those living in rural areas have the disease. 2 That translates to about 3.5 million people, and it does not include the estimated additional 1 million undiagnosed.…”

mentioning

confidence: 99%

“…2 That translates to about 3.5 million people, and it does not include the estimated additional 1 million undiagnosed. 2,3 Notably, even among never-smokers, rural residence and poverty are risk factors for COPD. 4 The disease also takes a heavy financial toll: national medical costs associated with COPD are projected to increase from $32.1 billion in 2010 to $49 billion in 2020.…”

mentioning

confidence: 99%

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COPD and Rural Health: A Dialogue on the National Action Plan

Moore

Atkins

Cramb

et al. 2019

The Journal of Rural Health

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Association Between Initiation of Pulmonary Rehabilitation After Hospitalization for COPD and 1-Year Survival Among Medicare Beneficiaries

Lindenauer

Stefan

Pekow

et al. 2020

JAMA

178

116

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IMPORTANCE Meta-analyses have suggested that initiating pulmonary rehabilitation after an exacerbation of chronic obstructive pulmonary disease (COPD) was associated with improved survival, although the number of patients studied was small and heterogeneity was high. Current guidelines recommend that patients enroll in pulmonary rehabilitation after hospital discharge. OBJECTIVE To determine the association between the initiation of pulmonary rehabilitation within 90 days of hospital discharge and 1-year survival. DESIGN, SETTING, AND PATIENTS This retrospective, inception cohort study used claims data from fee-for-service Medicare beneficiaries hospitalized for COPD in 2014, at 4446 acute care hospitals in the US. The final date of follow-up was December 31, 2015. EXPOSURES Initiation of pulmonary rehabilitation within 90 days of hospital discharge. MAIN OUTCOMES AND MEASURES The primary outcome was all-cause mortality at 1 year. Time from discharge to death was modeled using Cox regression with time-varying exposure to pulmonary rehabilitation, adjusting for mortality and for unbalanced characteristics and propensity to initiate pulmonary rehabilitation. Additional analyses evaluated the association between timing of pulmonary rehabilitation and mortality and between number of sessions completed and mortality. RESULTS Of 197 376 patients (mean age, 76.9 years; 115 690 [58.6%] women), 2721 (1.5%) initiated pulmonary rehabilitation within 90 days of discharge. A total of 38 302 (19.4%) died within 1 year of discharge, including 7.3% of patients who initiated pulmonary rehabilitation within 90 days and 19.6% of patients who initiated pulmonary rehabilitation after 90 days or not at all. Initiation within 90 days was significantly associated with lower risk of death over 1 year (absolute risk difference [ARD],-6.7% [95% CI,-7.9% to-5.6%]; hazard ratio [HR], 0.63 [95% CI, 0.57 to 0.69]; P < .001). Initiation of pulmonary rehabilitation was significantly associated with lower mortality across start dates ranging from 30 days or less (ARD,-4.6% [95% CI,-5.9% to-3.2%]; HR, 0.74 [95% CI, 0.67 to 0.82]; P < .001) to 61 to 90 days after discharge (ARD,-11.1% [95% CI,-13.2% to-8.4%]; HR, 0.40 [95% CI, 0.30 to 0.54]; P < .001). Every 3 additional sessions was significantly associated with lower risk of death (HR, 0.91 [95% CI, 0.85 to 0.98]; P = .01). CONCLUSIONS AND RELEVANCE Among fee-for-service Medicare beneficiaries hospitalized for COPD, initiation of pulmonary rehabilitation within 3 months of discharge was significantly associated with lower risk of mortality at 1 year. These findings support current guideline recommendations for pulmonary rehabilitation after hospitalization for COPD, although the potential for residual confounding exists and further research is needed.

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Urban-Rural County and State Differences in Chronic Obstructive Pulmonary Disease — United States, 2015

Cited by 166 publications

References 6 publications

County-Level Variations in Receipt of Surgery for Early-Stage Non-small Cell Lung Cancer in the United States

County-Level Variations in Receipt of Surgery for Early-Stage Non-small Cell Lung Cancer in the United States

COPD and Rural Health: A Dialogue on the National Action Plan

Association Between Initiation of Pulmonary Rehabilitation After Hospitalization for COPD and 1-Year Survival Among Medicare Beneficiaries

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