Browse ATS 2021 Abstracts

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ATS 2021 will feature presentations of original research from accepted abstracts. Mini Symposia and Thematic Poster Sessions are abstract based sessions.

Please use the form below to browse scientific abstracts and case reports accepted for ATS 2021. Abstracts presented at the ATS 2021 will be published in the Online Abstract Issue of the American Journal of Respiratory and Critical Care Medicine, Volume 203, May 3, 2021.

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Availability of Pulmonary Rehabilitation Among Medicare Beneficiaries with COPD

Session Title
A1155 - Availability of Pulmonary Rehabilitation Among Medicare Beneficiaries with COPD
Author Block: G. Malla1, S. Bodduluri2, S. P. Bhatt2; 1Epidemiology, University of Alabama at Birmingham, Birmingham, AL, United States, 2Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL, United States.
Rationale: Chronic Obstructive Pulmonary Disease (COPD) is the fourth leading cause of death in the US. Pulmonary rehabilitation (PR) results in significant improvement in dyspnea, respiratory quality of life, functional capacity, and hospitalization rates. A major barrier to PR is availability of and access to PR centers. Individuals who live >10 miles from a PR center are less than half as likely to enroll than those who live closer. We aimed to describe the geographic variation in availability of PR centers among Medicare beneficiaries with a COPD diagnosis.
Methods: From the Centers for Medicare and Medicaid Services, we used the ‘Chronic Conditions Summary’ and ‘Beneficiary Summary’ files for the 100% Medicare population with coverage in 2018. Individuals who met ICD 9 and ICD 10 codes for COPD at least once between 1/1/1999-12/31/2018 were included. Zipcodes of the beneficiaries were used to create 10 mile-, 15 mile-, 25 mile-, and 50 mile-radial geodesic distance-based buffers around the centroid of the zipcode. Street addresses of PR centers across the continental US were geocoded. We calculated a) distance between zipcode centroids and the closest PR center b) proportion of beneficiaries that had at least one PR center available within the four buffers. We also classified zipcodes into metropolitan, micropolitan and small-town/rural areas using the 2010 Rural-Urban Commuting Area Codes.
Results: We included 62,930,784 Medicare beneficiaries, of whom 10,376,949 (16.5%) had COPD. Mean age was 74.4 (SD=11.7) years, and the cohort was comprised of 55.8% females, 79.6% Non-Hispanic Whites, 10.2% Blacks, and 6.4% Hispanics. We identified 1,696 unique PR centers in US. The mean distance between the residents and nearest PR center was 12.3 (15.0) miles. The proportion of individuals with COPD who had a PR center available within 10-, 15-, 25-, and 50-mile radius was 61.5%, 73.3%, 86.6%, and 97.2%, respectively (Figure). A fourth of the beneficiaries with COPD resided in either micropolitan/ small-town/rural areas, with 1 center per 4300. The mean distance between the residents and their nearest PR center was 8.6 (10.1) miles in metropolitan areas, 20.0 (20.9) miles in micropolitan and 26.6 (20.2) miles in small-town/rural areas. In metropolitan areas, 72.8% had a PR center available within 10 miles, compared to 38.2% in micropolitan and 17.1% in small-town/rural areas.
Conclusions: Two-fourths of adults with COPD in the US have poor access to pulmonary rehabilitation. This deficiency was more pronounced in rural areas. These results have significant implications for disease management.