Why COPD is more common in rural areas

Chronic obstructive pulmonary disease (COPD) is a progressive lung condition that makes it difficult to breathe and can significantly impact quality of life.

While COPD affects people across all regions, research from the U.S. Centers for Disease Control and Prevention (CDC) recently found that COPD is more prevalent and often more severe in rural areas. The data from the CDC shows that:

• The percentage of adults in rural areas with COPD was 8.2%, which is double that of adults with COPD in large metropolitan areas.

• Hospitalizations for COPD among Medicare enrollees in rural areas were about 14 per 1,000, but only about 11 per 1,000 in large metropolitan centers.

• Death rates from COPD in rural areas were about 55 people per 100,000, compared to 32 people per 100,000 in large metropolitan areas.

Khazenay Bakhsh, DO, a pulmonary disease expert at Loma Linda University Health, says that the disparity stems from a complex mix of lifestyle, healthcare, and economic factors that create unique challenges for rural populations.

Lifestyle influences

Smoking remains the leading cause of COPD, with the World Health Organization reporting that 70% of COPD cases in high-income countries are due to tobacco smoking.

Bakhsh says that smoking is a far more common and accepted habit in rural communities than in metropolitan areas.

"In rural areas, smoking rates are often higher due to social norms with lower stigma associated with smoking and limited access to cessation programs," she explains.

Additionally, exposure to occupational hazards such as dust, chemicals, and biomass fuels may further increase COPD risks, according to the CDC.

Limited access to healthcare

Many rural residents live long distances from hospitals or specialty clinics, making it difficult to access regular care, schedule follow-up visits, or obtain prescription refills.

In addition, rural areas often suffer from a shortage of healthcare providers, especially pulmonologists who are essential for early diagnosis and disease management. This disparity is often due to rural regions receiving less healthcare funding and fewer resources than urban areas.

"Delayed diagnosis often means COPD is not identified until it has progressed to a moderate or severe stage, reducing treatment effectiveness and worsening patient outcomes," Bakhsh says.

Additionally, someone with COPD might experience further complications if they have a coexisting chronic condition - specifically diabetes, hypertension, and obesity -- which are more prevalent in rural populations. This can complicate a patient's COPD management and increase the risk of hospitalization and mortality.

Socioeconomic and social determinants

Rural areas often experience higher rates of poverty and lower education levels, which can limit access to medications and healthy lifestyle resources.

"Health literacy plays a role in understanding the importance of early detection, preventative care, and managing lifestyle factors such as smoking," Bakhsh says.

Geographic isolation also contributes to social isolation, making it harder for individuals to find or sustain support networks, such as smoking cessation groups or wellness programs.

Reducing the rural COPD gap

Bakhsh says addressing these disparities requires targeted, community-based, and systemic solutions. Some effective approaches include:

• Mobile clinics: Community outreach, such as mobile clinics, can go directly to patients to educate and provide care, as well as administer vaccines and smoking cessation education.

• Training: Teaching doctors in rural communities to effectively recognize and manage COPD is important because a specialist may not be readily available.

• Programs: Targeted smoking cessation programs and youth education initiatives, combined with community outreach, can help raise awareness about the risks of tobacco use.

• Telehealth: Telehealth appointments provide specialists with access to patients in rural areas.

• Transportation: Providing transportation assistance helps ensure that patients can go to appointments.

• Community support: Establishing support groups with other patients who have COPD can help those in rural communities not feel so isolated.

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