B44-28 Rural-Urban Disparities in COPD Prevalence and Symptom Burden: A Systematic Review

Abstract Rationale Chronic obstructive pulmonary disease (COPD) remains a major contributor to global morbidity, with prevalence patterns influenced by socioeconomic, environmental, and healthcare factors. Emerging data suggests that individuals residing in rural regions may bear a disproportionate disease burden compared to their urban counterparts, although how this translates on a global scale is less understood. We conducted a systematic review aimed at examining global differences in COPD prevalence and symptom burden between rural and urban populations. Methods We carried out comprehensive searches of Medline, Embase, Emcare, CINAHL, and Cochrane Central on 7th May 2025 to identify peer-reviewed studies directly comparing rural and urban COPD prevalence or symptom burden. Eligible studies were screened and assessed independently based on inclusion criteria. Study quality was appraised using the Newcastle-Ottawa Scale (NOS). Narrative synthesis was performed due to heterogeneity in study design and reporting. Results Of 2337 records identified, 21 studies met inclusion criteria. The definition of rurality showed significant heterogeneity between studies. Eighteen studies compared prevalence, with 28% (5/18) conducted in the United States of America (USA). 83% (15/18) of studies reported higher prevalence in rural areas compared to urban. This pattern was consistent across geographical distributions. Statistically significant differences (p 0.05) were reported in 73% (11/15) of studies demonstrating higher rural prevalence, with odds ratios ranging from 1.05 to 4.33 (figure 1). The majority of the statistically significant studies were ‘good’ (5/11) or ‘very good’ (4/11) quality. Six studies compared symptom burden with 83% (5/6) conducted in the USA and one in China. Measures included dyspnoea/cough (n = 2), COPD Assessment Test (n = 3) and the Medical Research Council (MRC) dyspnoea scale (n = 2). 83% (5/6) of studies reported higher symptom burden amongst rural patients, with 3/5 of these studies showing statistical significance. The single study demonstrating higher symptom burden in urban area was not statistically significant. Conclusion Globally, rural populations experience a higher prevalence of COPD compared to their urban counterparts. These findings underscore the impact of rural-urban disparities in healthcare provision, socioeconomic deprivation, smoking rates and environmental exposures. In the USA and China, there are higher levels of symptom burden amongst rural populations. Further studies are needed to examine if this pattern is consistent globally. This abstract is funded by: None