African American COPD Patients Underutilize Pulmonary Rehabilitation

Black patients with chronic obstructive pulmonary disease (COPD) were less likely to participate in pulmonary rehabilitation (PR) than white patients, regardless of the distance to the nearest PR program, according to an abstract presented at the 2019 American Thoracic Society (ATS) International Conference, held May 17-22 in Dallas, Texas.

While PR has been shown to improve outcomes for patients with COPD, especially for those who were hospitalized due to an exacerbation, overall rates of PR remain low across the United States.¹ Factors such as race, socioeconomic status, and distance to nearest PR program have been previously identified as strong predictors of PR participation.² Considering black and Hispanic populations tend to reside in different areas from non-Hispanic white populations, researchers presenting at ATS explored the importance of geographic factors when identifying strategies to increase rates of PR participation.² They conducted the study to determine if racial disparities in receipt of PR were influenced by the number of PR programs in a region and other community-level factors.

The study presented at ATS used CMS data from Medicare beneficiaries at least 66 years old who were hospitalized for COPD in 2012. The hospital referral region (HRR) was the geographic unit of analysis. PR programs were identified from CMS outpatient and carrier files, and their locations were geocoded to determine the density of PR programs at the HRR level.

The researchers first calculated overall HRR-level expected rates of PR adjusted for age, gender, and comorbidity burden. The rates were then separately calculated for black and white beneficiaries. They then examined whether racial disparities in PR utilization persisted after controlling for density of PR programs per 1000 Medicare beneficiaries. HRR-level predictors of PR were also examined.

Rates of PR broadly varied between HRRs, ranging from 0.52% to 7.1%. The average expected rate of PR receipt within 6 months of an index COPD hospitalization was 2.2%. Researchers found that racial disparities accounted for significant differences in PR receipt. The expected rate of PR receipt for whites, at the HRR-level, ranged from 0.6% to 7.3%, while the range for blacks was from 0.0% to 2.0%.

The strongest predictor of HRR-level rate of PR receipt was the density of PR programs per 1000 Medicare beneficiaries. Researchers found that an increasing density of providers was associated with increased rates of PR receipt, both overall and for white beneficiaries. However, among black beneficiaries, program density did not affect expected rates of PR receipt. Rates were found to be highest among HRRs in the Midwest and lowest in Western HRRs.

Researchers suggest that further studies are required to develop strategies to increase receipt of PR for all individuals.

“While PR program density was a strong predictor of overall rates of PR at the HRR level, rates of PR receipt for black beneficiaries remain low regardless of program density,” researchers concluded.

1. Spitzer KA, Stefan MS, Priya A, et al. Participation in pulmonary rehabilitation after hospitalization for chronic obstructive pulmonary disease among medicare beneficiaries. Ann Am Thorac Soc. 2019;16(1):99-106. doi: 10.1513/AnnalsATS.201805-332OC.

2. Spitzer KA, Stefan MS, Priya A, et al. Geographic and racial disparities in receipt of pulmonary rehabilitation following hospital discharge for COPD exacerbations. Presented at 2019 American Thoracic Society International Conference; May 17-22, 2019, Dallas, TX. Abstract A4271.

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