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Access and Quality of Care for Rural Patients with Chronic Obstructive Pulmonary Disease (COPD)
Chronic Obstructive Pulmonary Disease (COPD) is a set of progressive lung diseases including chronic bronchitis, emphysema, asthma, and other small-airways disease. An estimated 16 million individuals in the U.S. have COPD, resulting in over 800,000 hospitalizations per year with a hospital readmission rate close to 25%. COPD is the third leading cause of death in the U.S. after heart disease and cancer; COPD-related direct and indirect health costs have been estimated to be approximately $50 billion per year. COPD prevalence rates vary substantially by state, with the highest rates in states in the Southeast and Midwest. The COPD prevalence rate is estimated to be about 12% for individuals living in rural communities compared to 7% across the U.S. However, there has been limited research and policy analysis on healthcare access and quality issues for individuals with COPD, with even less focus on individuals with COPD who live in rural communities. This project aims address the large gap in the literature on key access and quality issues for the rural population with COPD by describing the prevalence of COPD in rural areas, and demographic characteristics and health status measures for rural patients with COPD; assessing access to care and availability of needed care and services for rural COPD patients; examining rural hospital COPD readmission and mortality measures and exploring data sources for future analyses of quality of care for rural COPD patients; and identifying strategies to help improve access to care for rural COPD patients.

Addressing Rural Social Isolation as a Health and Mortality Risk Factor
Social isolation, defined as a lack of contact with friends, family members, neighbors, and society at large, is directly related to increased morbidity and mortality, both of which are elevated in rural areas, compared with urban areas. Addressing social isolation should be viewed as a matter of primary prevention and as imperative to population health. The purpose of this project is to describe rural/urban differences in the prevalence of social isolation, as well as to identify challenges and strategies related to addressing rural social isolation in order to inform policy-making.

Caring for Caregivers: Available Support for Unpaid Caregivers in Rural Areas
Currently, more than 80% of all long-term care is provided by informal (unpaid) caregivers, usually family members, and more than 44 million Americans are currently providing unpaid care to a loved one, the majority of whom are older adults. The value of unpaid caregiving has been estimated at nearly $500 billion annually, yet it receives far less research attention than institutional care or home health services. Caregiving, especially without appropriate support, is associated with various poor health outcomes for the caregiver. While the entire US is aging quickly, rural areas are aging at a faster rate and have greater long-term care needs. Further, rural areas face shortages in the formal long-term care workforce, pushing even more of the burden of care to unpaid caregivers. Yet, caregiver support programs are scarcer in rural areas, leaving caregivers who may need help most at the greatest risk of not receiving it. This project aims to describe rural-urban differences in the prevalence and intensity of informal caregiving for older adults and associated socio-demographic correlates, and to identify potential policy interventions to improve the quality of life and health outcomes of rural caregivers.

Rural-Urban Differences in Opioid-Affected Pregnancies and Births
The opioid epidemic has had devastating health, social, and economic consequences for families across the U.S., with a disproportionate impact in rural areas. Non-medical opioid use and opioid use disorder during pregnancy are associated with poor maternal outcomes and adverse effects among infants. The diagnosis of maternal opioid use disorder in the U.S. increased disproportionately in rural counties from 2004 to 2013, indicating the need for rural-tailored information to inform opioid programs and policies.This analysis will describe the rates and predictors of non-medical opioid use prior to and during pregnancy and maternal diagnosis of opioid use disorder at birth, based on rural or urban maternal residence and rural or urban hospital location. It will inform targeting of resources to combat the opioid epidemic in rural communities.