Is Living in a Rural Area Good for Your Respiratory Health?

Results From a Cross-sectional Study in Scotland

Lisa Iversen, MSc; Philip C. Hannaford, MD; David B. Price, FRCGP; David J. Godden, MD


CHEST. 2005;128(4):2059-2067. 

In This Article

Abstract and Introduction

Study Objectives: We aimed to investigate the epidemiology of self-reported chronic respiratory disease throughout Scotland, and to explore the relationship between quality of life and geographic location in those reporting disease.
Design: A cross-sectional study. Self-reported data on age, gender, socioeconomic factors, smoking habits, selected illnesses (major respiratory and atopic diseases, and other major conditions), respiratory symptoms, use of medicines and health services, and quality of life were collected using a postal questionnaire.
Participants: A total of 4,560 adults registered with 1 of 57 family practices (22 rural and 35 urban) throughout Scotland.
Results: The response rate was 60%. Following adjustment for potential confounders, participants from rural areas reported a significantly lower prevalence of any chest illness (adjusted odds ratio [OR], 0.72; 95% confidence interval [CI], 0.58 to 0.91), asthma (adjusted OR, 0.59; 95% CI, 0.46 to 0.76), and eczema/dermatitis (adjusted OR, 0.67; 95% CI, 0.52 to 0.87). Rural location was less likely than urban location to be associated with the reporting of persistent cough and phlegm and different symptoms (types of breathlessness and wheeze) indicative of asthma. No difference in prevalence was found for other respiratory problems. Participants from rural areas reporting COPD or emphysema, or cough or phlegm symptoms had significantly better quality of life scores than their urban counterparts.
Conclusions: In this study, living in a rural area was associated with a lower prevalence of asthma but not other chronic respiratory disorders, and a lower prevalence of some respiratory symptoms (including wheeze). Although the prevalence of COPD or emphysema did not differ between rural and urban areas, rural residency appeared to be associated with better health status among subjects with these conditions.

It has been suggested that people living in rural areas generally report better health, are less likely to be disabled or suffer from a long-term limiting illness, and are less likely to smoke than those living in urban areas.[1] Rates of alcohol and drug dependence and psychiatric morbidity have been shown to be lower in rural rather than urban areas, although some of the difference may be due to socioeconomic differences.[2] In contrast, patients living remote from cities have worse survival from lung or colorectal cancer than those living in cities (because of more advanced disease at diagnosis).[3] In another study, standardized mortality ratios tended to be higher in the most rural areas than in other rural areas, perhaps indicating that any rural/urban gradient in mortality may not continue across the spectrum of locations.[4]

Several prevalence studies[5,6] have considered geographic variations in asthma and respiratory symptoms. Few have specifically considered rural/urban variations of such conditions, perhaps because there is no agreed definition of rurality. Various approaches exist based on population density, population size, and social characteristics, or remoteness from urban centers and health-care facilities.[7] Others advocate using a definition of rurality that is most sensible for the issue being examined.[8]

In the United Kingdom, exercise-induced bronchospasm among Highland schoolchildren was found to be significantly higher in one of the most rural areas studied (Skye) compared with the rest of the United Kingdom or other areas in the Highlands.[9] Others have found that wheeze in the past year, both with and without a diagnosis of asthma, and before adjustment for other factors, was lower in rural compared with urban areas.[10]

Chronic respiratory disease (asthma, chronic bronchitis, COPD, and emphysema) imposes significant health burdens and quality of life impairments.[11–14] Scottish data show that respiratory disease is the third most common diagnosis of inpatient and daycase discharges[1] and accounts for 8% of primary care prescribing.[15] Compared with urban areas, it is more expensive to deliver health-care services in rural parts of Scotland.[16] This may be because the cost of providing the same standard of care is higher, or because patterns of disease vary significantly between different locations. Furthermore, it is unknown whether the quality of life of individuals with chronic respiratory disease living in rural and urban areas is different. In addition to affecting the distribution of health services, differences in the prevalence of symptoms between rural and urban locations may provide clues toward mechanisms of disease and may give an indication of unmet need. Our cross-sectional study, although unable to consider cause and effect, was a suitable starting point for the future investigation of potential influences on the presentation of respiratory illness. Given the importance of chronic respiratory disease, we investigated the epidemiology of self-reported chronic respiratory disease across Scotland, and explored the relationship between quality of life and geographic location in those reporting such problems.


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