Risk of COPD hospitalizations and deaths among rural and urban veterans after successive COPD hospitalizations

Abstract: Background: COPD hospitalizations are associated with unfavorable outcomes, but the effect of each successive COPD hospitalization on future hospitalizations and death is understudied. Rural living is also a risk factor for COPD hospitalizations and mortality. Whether successive COPD hospitalizations are differentially associated with increased risk for future hospitalizations and death between rural and urban living is unknown. Aims: The aim of this study is to examine the association of each successive COPD hospitalization with the risk of future hospitalization and death in rural and urban individuals in a U.S. population. Methods: A retrospective cohort study was conducted using merged VA and Medicare data. A cohort of U.S. Department of Veterans Affairs (VA) patients aged 65 years or older with COPD hospitalization (October 1, 2011-September 30, 2014) was identified. COPD hospitalizations and mortality data were retrieved between the first COPD hospitalization and September 30, 2017. Rural residence was defined using Rural Urban Commuting Area codes assigned to the census tract of the patient's residential location. A Cox proportional hazards model was used to estimate the hazard ratio (HR) of future COPD hospitalization or all-cause death, accounting for repeated observations among patients. Results: The study found that each successive COPD hospitalization was associated with an increased risk of future hospitalization and death, with the risk increasing with each subsequent hospitalization. Rural living was associated with a higher risk of future hospitalization and death compared to urban living. The study also found that distance from patient residence to the nearest VA hospital and comorbidity index were associated with increased risk of future hospitalization and death. Conclusions: The study concludes that each successive COPD hospitalization is associated with an increased risk of future hospitalization and death, with the risk increasing with each subsequent hospitalization. Rural living is associated with a higher risk of future hospitalization and death compared to urban living. Distance from patient residence to the nearest VA hospital and comorbidity index are also associated with increased risk of future hospitalization and death. These findings highlight the need for targeted interventions to reduce COPD hospitalizations and improve outcomes, particularly in rural populations. Discussion: The study provides important insights into the association between successive COPD hospitalizations and future hospitalization and death, and the differential impact of rural and urban living on these outcomes. The study also highlights the importance of distance from patient residence to the nearest VA hospital and comorbidity index in predicting future hospitalization and death. These findings have important implications for the development of targeted interventions to reduce COPD hospitalizations and improve outcomes, particularly in rural populations. Further research is needed to identify effective interventions to reduce COPD hospitalizations and improve outcomes in this population.

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