Influence of deprivation on health care use, health care costs, and mortality in COPD

• Published in: International journal of chronic obstructive pulmonary disease 2018-01, Vol.13, p.1289-1296
• Main Authors: Collins, Peter F, Stratton, Rebecca J, Kurukulaaratchy, Ramesh J, Elia, Marinos
• Format: Article
• Language: English
• Subjects: Age; Chronic obstructive lung disease; Chronic obstructive pulmonary disease; deprivation; Economic aspects; economics; Exercise therapy; Health care costs; Health care expenditures; Health care reform; Health disparities; Hospitalization; Hospitals; Inner city; Malnutrition; Medical care utilization; Medical economics; Mortality; Original Research; Patient admissions; Patient outcomes; Risk factors; socioeconomic; Variance analysis
• ISSN: 1178-2005; 1176-9106; 1178-2005
• DOI: 10.2147/COPD.S157594

Deprivation is associated with the incidence of COPD, but its independent impact on clinical outcomes is still relatively unknown. This study aimed to explore the influence of deprivation on health care use, costs, and survival. A total of 424 outpatients with COPD were assessed for deprivation across two hospitals. The English Index of Multiple Deprivation (IMD) was used to establish a deprivation score for each patient. The relationship between deprivation and 1-year health care use, costs, and mortality was examined, controlling for potential confounding variables (age, malnutrition risk, COPD severity, and smoking status). IMD was significantly and independently associated with emergency hospitalization (β-coefficient 0.022, SE 0.007; =0.001), length of hospital stay, secondary health care costs (β-coefficient £101, SE £30; =0.001), and mortality (HR 1.042, 95% CI 1.015-1.070; =0.002). IMD was inversely related to participation in exercise rehabilitation (OR 0.961, 95% CI 0.930-0.994; =0.002) and secondary care appointments. Deprivation was also significantly related to modifiable risk factors (smoking status and malnutrition risk). Deprivation in patients with COPD is associated with increased emergency health care use, health care costs, and mortality. Tackling deprivation is complex; however, strategies targeting high-risk groups and modifiable risk factors, such as malnutrition and smoking, could reduce the clinical and economic burden.