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

TitleRural Residence and Chronic Obstructive Pulmonary Disease Exacerbations. Analysis of the SPIROMICS Cohort.
Publication TypePublication
Year2018
AuthorsBurkes RM, Gassett AJ, Ceppe AS, Anderson W, O'Neal WK, Woodruff PG, Krishnan JA, R Barr G, Han MK, Martinez FJ, Comellas AP, Lambert AA, Kaufman JD, Dransfield MT, J Wells M, Kanner RE, Paine R, Bleecker ER, Paulin LM, Hansel NN, M Drummond B
Corporate AuthorsCurrent and former investigators of the SPIROMICS sites and reading centers
JournalAnn Am Thorac Soc
Volume15
Issue7
Pagination808-816
Date Published2018 Jul
ISSN2325-6621
Abstract

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. 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. 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 ( = 204 rural and = 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. 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]; = 0.012) and a 46% higher incidence rate of total exacerbations (IRR 1.46 [95% CI, 1.02-2.10]; = 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]; = 0.05 and IRR 1.39 [95% CI, 0.97-1.99]; = 0.07). There was no difference in symptoms or airflow obstruction between rural and urban participants. 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.

DOI10.1513/AnnalsATS.201710-837OC
Alternate JournalAnn Am Thorac Soc
PubMed ID29584453
PubMed Central IDPMC6207115
Grant ListHHSN268200900019C / HL / NHLBI NIH HHS / United States
K23 ES025781 / ES / NIEHS NIH HHS / United States
P30 ES005605 / ES / NIEHS NIH HHS / United States
P30 ES006694 / ES / NIEHS NIH HHS / United States
R01 ES023500 / ES / NIEHS NIH HHS / United States
HHSN268200900015C / HL / NHLBI NIH HHS / United States
HHSN268200900016C / HL / NHLBI NIH HHS / United States
T32 HL007106 / HL / NHLBI NIH HHS / United States
U01 HL137880 / HL / NHLBI NIH HHS / United States
HHSN268200900018C / HL / NHLBI NIH HHS / United States
UL1 TR002319 / TR / NCATS NIH HHS / United States
HHSN268200900017C / HL / NHLBI NIH HHS / United States
HHSN268200900020C / HL / NHLBI NIH HHS / United States
HHSN268200900013C / HL / NHLBI NIH HHS / United States
R01 HL125432 / HL / NHLBI NIH HHS / United States
HHSN268200900014C / HL / NHLBI NIH HHS / United States
P30 ES009089 / ES / NIEHS NIH HHS / United States
MS#: 
MS092
Manuscript Full Title: 
Rural Residence and Chronic Obstructive Pulmonary Disease Exacerbations. Analysis of the SPIROMICS Cohort.
Manuscript Lead/Corresponding Author Affiliation: 
Genomics and Informatics Center (University of North Carolina at Chapel Hill)
ECI: 
Manuscript Status: 
Published and Public