Study Links Deprivation in Patients With COPD to Increased Costs and Mortality

Deprivation in patients with chronic obstructive pulmonary disease (COPD) is associated with increased emergency healthcare use, healthcare costs, and mortality rates, according to research.

A study published by the International Journal of Chronic Obstructive Pulmonary Disease investigated the association between deprivation and healthcare use, costs, and survival, in order to consider the independent impact of deprivation on clinical outcomes for patients with COPD.

“National and international policies aim to tackle health inequalities associated with deprivation, yet the health gradient between affluent and more-deprived communities continues to be of concern, with incidence rates for diseases such as COPD being significantly higher in deprived areas,” the study said.

The study included a total of 424 outpatients with COPD and assessed their deprivation across 2 hospitals in the United Kingdom. The researchers used the English Index of Multiple Deprivation (IMD) to determine a deprivation score for each patient. Each patient was assigned an IMD score based on their address (postcode) at the time they visited the clinic. Then the IMD created an overall estimation of deprivation based on income, employment, health deprivation/disability, education/training/skills, barriers to housing, crime, and living environment for each postcode.

The results revealed the IMD was significantly and independently associated with emergency hospitalizations, length of hospital stay, secondary healthcare costs, and mortality. Additionally, IMD was inversely related to participation in exercise rehabilitation and secondary care appointments and deprivation was also related to modifiable risk factors like smoking and malnutrition status.

“Considering that deprivation is unlikely to be easily addressed in the short term, clinical interventions should be focused on the potentially modifiable risk factors, such as malnutrition and smoking status,” the study stated. “Previous research suggests that socioeconomic differences in smoking cessation rates were not associated with the likelihood of attempting to stop smoking but were associated with success, suggesting that this may be due to greater nicotine dependence.”

The study noted the limitations of using retrospective data. For example, certain information was not available, such as the reason for hospitalization and cause of mortality.

The researchers hope that this study will highlight the importance of deprivation and encourage pharmacological and nonpharmacological interventions to consider deprivation as a potential barrier. The study also suggested the importance of future research to attempt to assess indicators of deprivation at the individual level.

“While deprivation is difficult to address, focused interventions on modifiable risk factors that cluster with deprivation, such as malnutrition risk and smoking status, could improve health outcomes in this particularly vulnerable patient group,” the authors concluded.

Reference

Collins PF, Stratton RJ, Kurukulaaratchy RJ, Elia M. Influence of deprivation on health care use, health care costs, and mortality in COPD. [published online April 19, 2018]. Int J Chron Obstruct Pulmon Dis. DOI: 10.2147/COPD.S157594