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Publication Briefs

Study Suggests Veterans with COPD Living in Isolated Rural Areas have Elevated Risk of Mortality

Chronic obstructive pulmonary disease (COPD) is a very common reason for acute medical hospitalizations and has an increasing mortality rate relative to other chronic diseases. Emerging evidence suggests that patients who reside in rural areas suffer worse health outcomes, but there is limited evidence about outcomes for rural patients living with COPD. This study sought to determine if COPD mortality is higher for Veterans living in isolated rural areas, and, if so, to assess whether or not hospital characteristics mediate such associations. Using a retrospective cohort design with VA data, investigators identified all consecutive admissions for COPD across 129 VA hospitals from October 2006 to September 2008. The primary outcome was 30-day mortality as assessed from the date of admission. Investigators also examined patient demographics and comorbidities, and categorized residence as urban (n=18,809, or 71%), rural (n=5,671, or 21%), or isolated rural (n=1,919, or 7%), as well as hospital rurality and volume.


  • Veterans living in the most isolated rural areas of the United States appear to have an elevated risk of COPD-related 30-day mortality. Overall unadjusted mortality was higher for Veterans from isolated rural areas (5.0%) and rural areas (4.0%) compared to Veterans from urban areas (3.8%). Hospital characteristics were not found to account for this effect.
  • Veterans from isolated rural but not rural areas remained at higher risk for death after adjusting for clinical characteristics, the proportion of COPD admissions in hospitals that came from rural areas, and hospital volume.
  • Veterans with COPD admitted to low-volume hospitals experienced an increase in mortality that approached statistical significance.


  • This study was limited to a sample of COPD inpatients and relied on administrative data enhanced with laboratory data.
  • Investigators did not have data on hospital resources known to be associated with variations in COPD mortality (e.g., specialty board certified faculty personnel, ventilatory support resources).

This study was supported by VA’s Rural Health Resource Center – Central Region, and HSR&D’s Center for Comprehensive Access and Delivery Research and Evaluation (CADRE), Iowa City, IA. Drs. Abrams, Vaughan-Sarrazin, and Kaboli are part of both centers.

PubMed Logo Abrams T, Vaughan-Sarrazin M, Fan V, and Kaboli P. Does Geographical Isolation Impact the Risk of Chronic Obstructive Pulmonary Disease-Related Mortality? Annals of Internal Medicine July 19, 2011;155(2):80-86.

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