People living in poor, rural areas are more likely to develop chronic obstructive pulmonary disease (COPD), even if they are not smokers, researchers report.

The prevalence of the disease among people living in poverty in rural locations was nearly twice that of the population as a whole (15.4% versus 8.4%) in one of the first studies to examine individual, community, and geographic risk factors for COPD in the United States.

Community use of coal for heating also represented an independent, additional risk factor for COPD among never-smokers.

Researchers linked data at a census-tract level from the National Health Interview Survey from 2012 through 2015 to the Census Bureau’s 2015 American Community Survey of more than 90,000 adults over age 4o.

The analysis was published online in the American Journal of Respiratory and Critical Care Medicine.

While non-smoking contributors to COPD at the international level have been widely studied — such as the burning of biomass for fuel — little is known about regional differences in COPD prevalence in the United States, wrote Meredith McCormack, MD, of Johns Hopkins University in Baltimore, and colleagues.

“Beyond smoking, other exposures and risk factors that may contribute to COPD development include exposure to indoor and outdoor pollution, and solid fuel (coal and wood) combustion — exposures that are likely to differ between urban and rural areas,” the team wrote.

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