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

Sandra Søgaard Tøttenborg; Peter Lange; Søren Paaske Johnsen; Henrik Nielsen; Truls Sylvan Ingebrigtsen; Reimar Wernich Thomsen

doi:10.1016/j.rmed.2016.09.007

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

Sandra Søgaard Tøttenborg, Peter Lange, Søren Paaske Johnsen, Henrik Nielsen, Truls Sylvan Ingebrigtsen, Reimar Wernich Thomsen

Section of Social Medicine

38 Citations (Scopus)

Abstract

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.

Original language	English
Journal	Respiratory Medicine
Volume	119
Pages (from-to)	160-167
Number of pages	8
ISSN	0954-6111
DOIs	https://doi.org/10.1016/j.rmed.2016.09.007
Publication status	Published - 1 Oct 2016

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1016/j.rmed.2016.09.007

http://www.resmedjournal.com/article/S095461111630230X/pdf

Cite this

@article{3354dffb7ade44e4b10be33a4173f0e6,

title = "Socioeconomic inequalities in adherence to inhaled maintenance medications and clinical prognosis of COPD",

abstract = "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.",

author = "T{\o}ttenborg, {Sandra S{\o}gaard} and Peter Lange and Johnsen, {S{\o}ren Paaske} and Henrik Nielsen and Ingebrigtsen, {Truls Sylvan} and Thomsen, {Reimar Wernich}",

year = "2016",

month = oct,

day = "1",

doi = "10.1016/j.rmed.2016.09.007",

language = "English",

volume = "119",

pages = "160--167",

journal = "Respiratory Medicine",

issn = "0954-6111",

publisher = "Elsevier",

}

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

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 -

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

Abstract

UN SDGs

Access to Document

Fingerprint

Cite this