Socioeconomic inequalities in adherence to inhaled maintenance medications and clinical prognosis of COPD

TY - JOUR

T1 - Socioeconomic inequalities in adherence to inhaled maintenance medications and clinical prognosis of COPD

AU - Tøttenborg, Sandra Søgaard

AU - Lange, Peter

AU - Johnsen, Søren Paaske

AU - Nielsen, Henrik

AU - Ingebrigtsen, Truls Sylvan

AU - Thomsen, Reimar Wernich

N1 - Copyright © 2016 Elsevier Ltd. All rights reserved.

PY - 2016/10/1

Y1 - 2016/10/1

N2 - Background Low socioeconomic status has been associated with adverse outcomes in chronic obstructive pulmonary disease (COPD), but population-based data are sparse. We examined the impact of education, employment, income, ethnicity, and cohabitation on the risk of suboptimal adherence to inhaled medication, exacerbations, acute admissions, and mortality among COPD patients. Methods Using nationwide healthcare registry data we identified 13,369 incident hospital clinic outpatients with COPD during 2008–2012. We estimated medication adherence as proportion of days covered (PDC) one year from first contact. With Poisson regression we computed adjusted relative risks (aRR) of poor adherence and non-use. With Cox regression we calculated adjusted hazard ratios (aHR) of clinical outcomes. Results 32% were poor adherers (PDC<0.8) and 5% non-users (PDC = 0). Analyses showed a higher risk of poor adherence among unemployed (aRR1.36, 95% CI 1.20–1.54), low income patients (aRR = 1.07, 95% CI 1.00–1.16), immigrants (aRR = 1.29, 95% CI 1.17–1.44), and patients living alone (aRR = 1.17, 95% CI 1.11–1.24). Similarly, non-use was associated with unemployment (aRR = 2.75, 95% CI 2.09–3.62), low income (aRR = 1.37, 95% CI 1.10–1.70), immigrant status (aRR = 1.56, 95% CI 1.17–2.08), and living alone (aRR = 1.53, 95% CI 1.30–1.81). Low education was associated with exacerbations (aHR = 1.21, 95% CI 1.10–1.35) and admissions (aHR = 1.22, 95% CI 1.07–1.38). Low income was associated with admissions (aHR = 1.20, 95% CI 1.09–1.32), and death (aHR = 1.11, 95% CI 0.99–1.25). The unemployed and those living alone had lower exacerbation-risk but higher mortality-risk. Conclusions In Denmark, health equity is a stated priority in a public health care system. Nevertheless, there are substantial socioeconomic inequalities in COPD treatment and outcomes.

AB - Background Low socioeconomic status has been associated with adverse outcomes in chronic obstructive pulmonary disease (COPD), but population-based data are sparse. We examined the impact of education, employment, income, ethnicity, and cohabitation on the risk of suboptimal adherence to inhaled medication, exacerbations, acute admissions, and mortality among COPD patients. Methods Using nationwide healthcare registry data we identified 13,369 incident hospital clinic outpatients with COPD during 2008–2012. We estimated medication adherence as proportion of days covered (PDC) one year from first contact. With Poisson regression we computed adjusted relative risks (aRR) of poor adherence and non-use. With Cox regression we calculated adjusted hazard ratios (aHR) of clinical outcomes. Results 32% were poor adherers (PDC<0.8) and 5% non-users (PDC = 0). Analyses showed a higher risk of poor adherence among unemployed (aRR1.36, 95% CI 1.20–1.54), low income patients (aRR = 1.07, 95% CI 1.00–1.16), immigrants (aRR = 1.29, 95% CI 1.17–1.44), and patients living alone (aRR = 1.17, 95% CI 1.11–1.24). Similarly, non-use was associated with unemployment (aRR = 2.75, 95% CI 2.09–3.62), low income (aRR = 1.37, 95% CI 1.10–1.70), immigrant status (aRR = 1.56, 95% CI 1.17–2.08), and living alone (aRR = 1.53, 95% CI 1.30–1.81). Low education was associated with exacerbations (aHR = 1.21, 95% CI 1.10–1.35) and admissions (aHR = 1.22, 95% CI 1.07–1.38). Low income was associated with admissions (aHR = 1.20, 95% CI 1.09–1.32), and death (aHR = 1.11, 95% CI 0.99–1.25). The unemployed and those living alone had lower exacerbation-risk but higher mortality-risk. Conclusions In Denmark, health equity is a stated priority in a public health care system. Nevertheless, there are substantial socioeconomic inequalities in COPD treatment and outcomes.

U2 - 10.1016/j.rmed.2016.09.007

DO - 10.1016/j.rmed.2016.09.007

M3 - Journal article

C2 - 27692139

SN - 0954-6111

VL - 119

SP - 160

EP - 167

JO - Respiratory Medicine

JF - Respiratory Medicine

ER -