Pulmonary Rehab for COPD: Closing the Geographic and Racial Gaps

pulmonary rehabilitation walking exercise
The rates of participation in pulmonary rehabilitation programs following hospitalization for COPD vary widely across regions in the United States

The rates of participation in pulmonary rehabilitation programs following hospitalization for chronic obstructive pulmonary disease (COPD) vary widely across the United States and are only weakly associated with program density.

In addition, racial disparities in pulmonary rehabilitation participation do not appear to be explained by differences in access, implying that merely creating more programs will not alleviate this issue. A retrospective study was conducted with the use of Centers for Medicare and Medicare Services (CMS) beneficiary summary files and standard analytic files that included individuals who were hospitalized in an acute care hospital in 2012. The results of the analysis were published in CHEST.

Investigators sought to explore whether the density of pulmonary rehabilitation programs could explain regional variation and racial disparities in the receipt of pulmonary rehabilitation in patients with COPD. They used CMS data from a total of 223,832 Medicare beneficiaries who were hospitalized for COPD in 2012 and were eligible for pulmonary rehabilitation following discharge from the hospital. Hospital-Referral Regions (HRRs) were used as the unit of analysis. For each HRR, the density of pulmonary rehabilitation programs was calculated as a measure of program access. The researchers estimated risk-standardized rates of pulmonary rehabilitation within 6 months of discharge overall, as well as for non-Hispanic, white, and black beneficiaries.

In a total of 306 HRRs, the median number of pulmonary rehabilitation programs per 1000 Medicare beneficiaries was 0.06. Risk-standardized rates of pulmonary rehabilitation use ranged from 0.53% to 6.66% (median, 1.93%). The density of pulmonary rehabilitation programs was significantly associated with pulmonary rehabilitation rates overall and pulmonary rehabilitation rates in non-Hispanic white beneficiaries (P <.001), but this same positive relationship was not reported in black beneficiaries. Moreover, the rates of pulmonary rehabilitation use were higher in non-Hispanic white beneficiaries compared with black beneficiaries (median, 2.08% vs 1.19%, respectively).

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The investigators concluded that additional research is warranted to elucidate the reasons for this discrepancy and to develop strategies to increase pulmonary rehabilitation participation in black beneficiaries with COPD who may face additional barriers accessing pulmonary rehabilitation.


Spitzer KA, Stefan MS, Priya A, et al. A geographic analysis of racial disparities in use of pulmonary rehabilitation after hospitalization for COPD exacerbation [published online January 17, 2020]. CHEST. doi:10.1016/j.chest.2019.11.044