Deaths from CLRD increasing in rural U.S., while rural-urban gap in mortality is widening

The study examined trends in mortality due to chronic lower respiratory disease and investigated disparities in deaths due to CLRD between rural and urban areas across the United States.

3D Illustration Concept of Human Respiratory System Lungs AnatomyThe study examined trends in mortality due to chronic lower respiratory disease and investigated disparities in deaths due to CLRD between rural and urban areas across the United States.A new study by University of Alabama at Birmingham researchers  shows that chronic lower respiratory disease-associated mortality is higher in rural compared to urban areas. Rising deaths due to CLRD in rural areas, compared to a decline in urban areas, has generated a widening rural-urban gap in CLRD deaths over the past 20 years. The study was published in the American Journal of Respiratory and Critical Care Medicine

CLRD, including asthma and chronic obstructive pulmonary disease, is the fourth leading cause of death in the United States and more prevalent in rural areas, where access to pulmonologists is limited and many rural hospitals have closed. 

Anand S. Iyer, M.D., MSPH, assistant professor in the UAB Division of Pulmonary, Allergy and Critical Care, and his fellow researchers analyzed 2,754,413 CLRD-attributable deaths between 1999 and 2018 from the national Centers for Disease Control and Prevention Wide-ranging ONline Data for Epidemiologic Research, or CDC WONDER, database.  

They found that, though CLRD-associated mortality declined in urban areas over the past two decades, deaths attributable to CLRD increased in rural areas. The most notable increases in CLRD-associated mortality in rural America occurred in middle-aged adults, females and non-Hispanic whites.

Iyer said their findings are concerning. 

“Death rates due to CLRD in rural America are rising, and the gap between deaths in rural versus urban areas is widening,” Iyer said. “We must better understand why these are occurring and develop public health approaches to slow them.”

Iyer added that there are ways to reduce these rural-urban disparities for CLRD, potentially through expanding Medicaid to provide better access to care and tobacco cessation programs, improving financial support for costly inhalers that improve outcomes, and reversing the trends in rural hospital closures so that people with COPD and asthma have acute care centers close to home when their disease flares up.

chronic.4Anand S. Iyer, M.D., MSPH“Seventeen hospitals that serve predominately rural areas in Alabama have closed in the past decade, so many counties in Alabama do not have hospitals or have few primary care physicians,” he said. “Other ways could be to improve access to telehealth so that subspecialty pulmonologists can work with primary care clinicians to provide earlier insight and guidance into the care of people living with COPD and asthma. The COVID-19 pandemic has shed a light on the positive impact of telehealth in Alabama, but to really reach rural areas will take statewide broadband infrastructure that we don’t yet have and continued support from insurance companies.”

Iyer said other investigators on UAB’s campus are studying rural-urban disparities to clearly define what the problem is in Alabama across different health conditions and in minority and underserved populations.

“UAB is reaching out to rural areas across our state through telehealth, training rural health scholars and partnering with rural health care facilities,” he said. “UAB eMedicine enables pulmonologists typically concentrated in metropolitan areas to virtually see patients across long distances, thus saving cumbersome travel for older adults who live in rural and small towns. UAB also has many pipelines for rural health scholars in medicine, nursing and other disciplines to receive training to serve rural populations. UAB Health System has also entered into partnerships with rural hospitals and insurance companies to stabilize the crises at many small, rural facilities.”