A group of researchers from the Medical and Scientific Advisory Committee of the COPD Foundation is calling for its fellow researchers to increase the focus on rural health disparities in future COPD research.
The perspective, “Improving Research for COPD in Rural Areas: A Statement From the COPD Foundation Medical and Scientific Advisory Committee,” was published in Chronic Obstructive Pulmonary Disease: Journal of the COPD Foundation.
The researchers wrote that, whether confirmed by spirometry or defined via self-reporting, COPD is higher in rural areas across all age groups and all U.S. regions. However, differences in COPD prevalence exist between rural and urban regions, even after controlling for tobacco exposure and socioeconomic status.
In addition, they wrote that rural COPD patients have increased symptoms, worse lung function, increased exacerbations and higher death rates than those living in metropolitan areas.
“COPD mortality among individuals living in nonmetropolitan areas continues to increase, while COPD mortality in metropolitan areas has stabilized,” the committee wrote in the statement. “These observations highlight the persistent, widening health gap between rural and nonrural people with COPD. There is an urgent need to develop new strategies to study interventions and deliver proven therapies to improve COPD outcomes among people living in rural areas.”
According to the researchers, there are several factors that contribute to the complexity of rural COPD. These include:
- Distance and geographic isolation make it difficult to access health services.
- Access to reliable broadband and cellular service limits the effectiveness of telehealth in rural areas.
- The complex tobacco and exposure histories of rural residents have not been rigorously assessed in studies, including smoking during pregnancy and environmental exposures like biomass fuel combustion.
M. Bradley Drummond, MD, MHS, professor of medicine in the division of pulmonary diseases and critical care medicine at the University of North Carolina in Chapel Hill, said in a news release that research must be fine-tuned to deal with these factors.
“In order to address the rural-urban disparity as it relates to the risk and progression of COPD, we must continue to adjust and refine how we define rurality to ensure research examines all the contributing factors faced by people in rural areas,” Dr. Drummond said.
Another complication to these factors, the researchers explained, is rural cohorts in research and clinical trials may not reflect the broader rural populations. Traditional sources of cohorts — such as the Veterans Affairs Administration — may not account for the full spectrum of diversity within the rural population and may lead to minority subsets of that population being excluded from clinical trials.
To improve the design of COPD research studies in rural settings, the researchers suggested several strategies, including:
- Incorporating distance as a covariate in clinical trial design
- Using research tools designed to capture multidimensional assessments of societal and individual health determinants
- Applying qualitative research study design to assess cultural differences driving disparate outcomes
- Employing spoke-and-hub or “carousel” models of recruitment
- Integrating implementation science to identify scalable, sustainable solutions and optimize health care delivery
- Operationalizing research partnerships to support primary care providers
“We need new methodologies to study COPD in rural populations,” the researchers wrote. “Moving towards nuanced descriptors of rurality encompassing geographic distance, socioeconomic status and insurance access — in addition to racial and ethnic health disparity — will allow us to generate more informative clinical trials data.”
