Adult Chronic Respiratory Disease in Rural Versus Urban Areas: Is Age of Housing an Environmental Justice Issue?

Background: This research investigated and identified significant spatial clusters of asthma and chronic obstructive pulmonary disease (COPD)-related emergency department (ED) visits and in-patient (IP) hospitalizations, and social determinants of health in Sangamon County, IL. Sangamon County falls in the worst quartile of Illinois counties for age-adjusted asthma ED visits from years 2016 to 2018 (40.69/10,000 adults) and hospitalization rates from years 2009 to 2011 (14.4/10,000 adults). Age-adjusted COPD ED visits were 28.3/10,000 adults compared with 17.7/10,000 adults in Illinois. Age-adjusted COPD IP visits from years 2009 to 2011 were 21.1/10,000. Methods: Patients within the Sangamon County, Illinois geographic boundary were mapped according to diagnosis for a total of 385 unique patients with a 99% match rate. 2014 U.S. Census American Community Survey (ACS) data provided key sociodemographic variables associated with disadvantaged communities and health disparities, including education level and employment. Results: Overall, low median income, lower median year of housing structure, and percent health insurance emerged as key spatial indicators of COPD IP/ED and asthma ED visits. Significant clustering between health outcomes and these variables deviates from current large urban-based research literature on asthma and COPD. Discussion: Analysis of other types of socioeconomic, housing, and health insurance variables revealed that significant spatial components were nonexistent in rural areas. Rural social determinants of health indicators are markedly different from current respiratory disease literature. Conclusion: Further studies are needed, which are particularly important for those with chronic respiratory conditions who live in older homes.