The Impact of COPD on Quality of Life, Productivity Loss, and Resource Use among the Elderly United States Workforce

Figures & data

Figure 1.  Flow chart depicting the inclusion and exclusion criteria.

Table 1.  Demographics and health history of employed persons aged 65 years and older

	Unweighted n	Weighted n	Weighted%	Weighted SE
Age
65 to 69 years	2269	3320150	54.13%	1.31%
70 to 74 years	770	1038819	16.94%	0.68%
75 to 79 years	239	1314072	21.43%	1.40%
80 years or older	80	460266	7.50%	1.03%
Male	1851	3159486	51.51%	1.26%
Race/Ethnicity
White	3102	4892770	79.77%	1.45%
Black/African-American	116	469814	7.66%	1.01%
Hispanic	69	400802	6.53%	0.82%
Other	71	369922	6.03%	1.03%
Married/Living with partner	2148	3679522	59.99%	1.25%
College Educated	2855	5282378	86.13%	0.76%
Household income
Less than $25,000	376	816426	13.31%	1.01%
$25,000 to $49,999	999	1830972	29.85%	1.10%
$50,000 to $74,999	747	1274580	20.78%	0.99%
$75,000 and over	989	1705491	27.81%	1.12%
Decline to answer	247	505839	8.25%	0.70%
Employment
Full-time	1039	1712044	27.91%	1.06%
Part-time	881	1777972	28.99%	1.21%
Self-employed	1438	2643292	43.10%	1.24%
Health insurance	3241	5918554	96.50%	0.47%
Health insurance with Rx coverage	2827	5148008	83.94%	0.89%
BMI
Underweight	81	152751	2.49%	0.37%
Normal	882	1753963	28.60%	1.23%
Overweight	1323	2445504	39.87%	1.23%
Obese	1072	1781090	29.04%	1.02%
Decline to answer	50	89972	1.47%	0.28%
Diagnosed with asthma	198	336897	5.49%	0.54%
Diagnosed with COPD	297	560657	9.14%	0.78%
Smoking Habits
Never	1225	2387901	38.93%	1.29%
Former	1698	3057163	49.85%	1.25%
Current	435	688244	11.22%	0.64%
Resource Use (past six months)
Visited traditional provider	3040	5563086	90.70%	0.82%
Visited ER	340	667562	10.88%	0.90%
Visited hospital	304	565303	9.22%	0.76%
	Unweighted Mean	Weighted Mean	Weighted SD	Weighted SE
Charlson Comorbidity index	0.68	0.69	0.84	0.02
Quality of life (SF-12v2)
Mental component summary (MCS)	53.45	53.88	6.53	0.14
Physical component summary (PCS)	46.89	46.55	7.75	0.17
Health utilities	0.79	0.79	0.1	0
Work productivity
Absenteeism%	2.33	2.79%	10.6	0.24
Absenteeism (number of hours)	0.78	0.88	3.62	0.08
Presenteeism%	10.22	9.63%	14.26	0.33
Presenteeism (number of hours)	2.86	2.78	4.64	0.11
Overall work impairment%	11.77	11.57%	17.29	0.39
Activity impairment%	15.53	15.36%	18.08	0.4
Number of provider visits in the past six months	4.76	4.81	4.2	0.09
Number of ER visits in the past six months	0.14	0.15	0.46	0.01
Number of hospitalizations in the past six months	0.11	0.11	0.31	0.01

SD = standard deviation, Rx = prescription, BMI = body mass index, MCS = mental component summary, PCS = physical component summary, ER = emergency room.

Table 2.  Comparison of employed adults aged 65 years and older with and without COPD

	COPD Workers				Control Workers
	n = 297				n = 3,061
	n	Weighted n	Weighted%	Weighted 95% CI	n	Weighted n	Weighted%	Weighted 95% CI	p-value
Male	157	227157	40.52%	(32.7%–48.34%)	1694	2932329	52.62%	(50.05%–55.19%)	0.0115
Ethnicity
White	281	477457	85.16%	(74.93%–95.39%)	2821	4415313	79.23%	(76.29%–82.17%)	0.2551
Black/African-American	7	47168	8.41%	(0.00%–18.43%)	109	422647	7.58%	(5.66%–9.5%)	0.8744
Hispanic	3	18293	3.26%	(0.00%–6.93%)	66	382510	6.86%	(5.14%–8.58%)	0.0816
Other	6	17740	3.16%	(0.57%–5.75%)	65	352182	6.32%	(4.11%–8.53%)	0.0741
Married/Living with partner	166	292322	52.14%	(43.36%–60.92%)	1982	3387200	60.78%	(58.57%–62.99%)	0.0601
College Educated	249	482049	85.98%	(80.84%–91.12%)	2606	4800330	86.14%	(84.59%–87.69%)	0.9528
Household income
Less than $25,000	44	89122	15.90%	(10.04%–21.76%)	332	727303	13.05%	(10.95%–15.15%)	0.3674
$25,000 to $49,999	110	189147	33.74%	(26.1%–41.38%)	889	1641825	29.46%	(27.23%–31.69%)	0.2841
$50,000 to $74,999	56	85136	15.19%	(10.39%–19.99%)	691	1189444	21.34%	(19.28%–23.4%)	0.0303
$75,000 and over	72	164865	29.41%	(19.65%–39.17%)	917	1540626	27.65%	(25.45%–29.85%)	0.7337
Employment
Full-time	87	132697	23.67%	(17.61%–29.73%)	952	1579347	28.34%	(26.14%–30.54%)	0.1739
Part-time	69	143932	25.67%	(18.44%–32.9%)	812	1634041	29.32%	(26.81%–31.83%)	0.3555
Self-employed	141	284029	50.66%	(41.84%–59.48%)	1297	2359263	42.34%	(39.85%–44.83%)	0.0918
Health insurance	287	547997	97.74%	(96.31%–99.17%)	2954	5370557	96.37%	(95.37%–97.37%)	0.134
Health insurance with Rx coverage	249	480341	85.67%	(80.63%–90.71%)	2578	4667667	83.76%	(81.9%–85.62%)	0.49
BMI
Underweight	12	21468	3.83%	(0.93%–6.73%)	69	131283	2.36%	(1.63%–3.09%)	0.3346
Normal	93	213031	38.00%	(28.42%–47.58%)	789	1540933	27.65%	(25.2%–30.1%)	0.058
Overweight	113	187220	33.39%	(25.94%–40.84%)	1210	2258285	40.52%	(37.97%–43.07%)	0.0921
Obese	79	138939	24.78%	(18.16%–31.4%)	993	1642151	29.47%	(27.37%–31.57%)	0.1998
Diagnosed with Asthma	61	95277	16.99%	(11.91%–22.07%)	137	241620	4.34%	(3.28%–5.4%)	<.0001
Smoking Habits
Never	46	131708	23.49%	(13.32%–33.66%)	1179	2256193	40.49%	(37.88%–43.1%)	0.0005
Former	175	313600	55.93%	(46.78%–65.08%)	1523	2743564	49.23%	(46.68%–51.78%)	0.1536
Current	76	115349	20.57%	(14.93%–26.21%)	359	572895	10.28%	(9.01%–11.55%)	0.0002
Resource use (past six months)
Visited traditional provider	284	544479	97.11%	(95.5%–98.72%)	2756	5018607	90.06%	(88.32%–91.8%)	<.0001
Visited ER	53	130246	23.23%	(13.27%–33.19%)	287	537316	9.64%	(8.05%–11.23%)	0.0178
Visited hospital	44	78591	14.02%	(8.88%–19.16%)	260	486712	8.73%	(7.18%–10.28%)	0.0498
Charlson Comorbidity Index	1.8	1.82	0.92	(1.68–1.96)	0.57	0.58	0.78	(0.54–0.62)	<.0001
Quality of Life (SF-12v2)
Mental Component Summary (MCS)	50.91	51.69	7.71	(50.59–52.79)	53.7	54.1	6.38	(53.81–54.39)	<.0001
Physical Component Summary (PCS)	39.31	38.31	8.08	(37.15–39.47)	47.62	47.38	7.42	(47.05–47.71)	<.0001
Health state utilities	0.71	0.71	0.1	(0.69–0.73)	0.8	0.8	0.1	(0.8–0.8)	<.0001
Work Productivity
Absenteeism%	4.45%	9.14%	20.66%	(6.06%–12.22%)	2.12%	2.17%	8.93%	(1.76%–2.58%)	<.0001
Absenteeism hours	1.08	1.88	4.32	(1.27–2.49)	0.75	0.77	3.53	(0.61–0.93)	<.0001
Presenteeism%	19.56%	18.72%	18.14%	(15.92%–21.52%)	9.33%	8.79%	13.66%	(8.14%–9.44%)	<.0001
Presenteeism hours	4.75	4.82	5.11	(4.04–5.6)	2.68	2.59	4.56	(2.37–2.81)	<.0001
Overall work impairment%	22.29%	25.42%	24.80%	(21.72%–29.12%)	10.76%	10.21%	16.00%	(9.47%–10.95%)	<.0001
Activity impairment%	29.60%	29.90%	20.82%	(26.92%–32.88%)	14.17%	13.90%	17.39%	(13.12%–14.68%)	<.0001
Number of provider visits in the past six months	6.24	7.00	4.86	(6.31–7.69)	4.62	4.59	4.09	(4.41–4.77)	<.0001
Number of ER visits in the past six months	0.27	0.30	0.54	(0.22–0.38)	0.13	0.14	0.45	(0.12–0.16)	<.0001
Number of Hospitalizations in the past six months	0.19	0.17	0.37	(0.11–0.23)	0.11	0.11	0.3	(0.09–0.13)	0.007

Due to a Bonferroni correction to adjust the experimentwise error rate, statistical significance was set a priori to p < .00125 for these bivariate comparisons.

CI = confidence interval, Rx = prescription, BMI = body mass index, ER = emergency room, M = Mean, SD = standard deviation.

Table 3.  The adjusted effect of diagnosed COPD on health-related quality of life component summary scores

	Mental component summary			Physical component summary
	b	95%CI	p-value	b	95%CI	p-value
Intercept	52.76	(50.9–54.62)	<.0001	48.95	(46.9–51.01)	<.0001
Female	−0.12	(−0.74–0.51)	0.71	−1.12	(−1.81–0.43)	0.0014
Part-time employed	−0.75	(−1.49–0.01)	0.05	−2.27	(−3.09–1.45)	<.0001
Self-employed	0.71	(0.02–1.4)	0.04	−0.71	(−1.47–0.06)	0.0692
African-American	0.22	(−0.84–1.28)	0.68	−0.78	(−1.95–0.39)	0.1918
Hispanic	−0.86	(−1.99–0.26)	0.13	0.79	(−0.46–2.04)	0.2142
Other race	1.78	(0.59–2.97)	0.00	0.37	(−0.95–1.68)	0.5838
Married/Living with partner	0.39	(−0.25–1.03)	0.23	0.75	(0.04–1.46)	0.039
High school or less	−0.95	(−1.78–0.12)	0.03	−0.04	(−0.95–0.88)	0.9378
Income: $25k to $50k	0.65	(−0.28–1.57)	0.17	−0.06	(−1.08–0.97)	0.9149
Income: $50k to < $75k	1.00	(−0.03–2.03)	0.06	0.17	(−0.97–1.31)	0.771
Income: $75k+	1.55	(0.53–2.58)	0.00	1.59	(0.46–2.72)	0.006
Income: decline to answer	2.60	(1.34–3.87)	<.0001	1.26	(−0.14–2.65)	0.078
Insurance	0.62	(−1.07–2.31)	0.47	1.38	(−0.49–3.25)	0.1468
Insurance with Rx coverage	0.51	(−0.34–1.35)	0.24	0.28	(−0.66–1.21)	0.561
Diagnosed with Asthma	−4.36	(−5.59–3.13)	<.0001	−2.14	(−3.5–0.78)	0.0021
Underweight	0.66	(−2.12–3.43)	0.64	2.97	(−0.1–6.05)	0.0577
Overweight	0.04	(−0.64–0.73)	0.90	−0.94	(−1.7–0.18)	0.0153
Obese	−1.83	(−2.58–1.09)	<.0001	−5.07	(−5.89–4.25)	<.0001
Weight: decline to answer	0.91	(−1.44–3.26)	0.45	−7.62	(−10.21–5.02)	<.0001
Charlson comorbidity index	−0.31	(−0.59–0.04)	0.03	−1.66	(−1.97–1.35)	<.0001
Current smoker	−2.39	(−3.34–1.44)	<.0001	0.46	(−0.59–1.51)	0.391
Former smoker	0.36	(−0.24–0.96)	0.24	0.57	(−0.09–1.23)	0.0917
Diagnosed with COPD	−1.29	(−2.33–0.25)	0.02	−6.90	(−8.05–5.75)	<.0001

CI = confidence interval.

Table 4.  The adjusted effect of diagnosed COPD on work productivity and activity impairment scores

	Absenteeism			Presenteeism			Overall work impairment			Activity impairment
	b	95%CI	p-value	b	95%CI	p-value	b	95%CI	p-value	b	95%CI	p-value
Intercept	1.28	(−0.26–2.82)	0.1031	2.17	(1.66–2.68)	<.0001	2.25	(1.76–2.75)	<.0001	2.45	(2.07–2.83)	<.0001
Female	0.57	(0.07–1.07)	0.0249	0.23	(0.06–0.4)	0.0068	0.31	(0.14–0.48)	0.0004	0.28	(0.15–0.41)	<.0001
Part-time employed	−0.19	(−0.79–0.4)	0.5242	0.24	(0.04–0.43)	0.0169	0.19	(−0.01–0.38)	0.0618	0.28	(0.13–0.44)	0.0002
Self employed	−0.69	(−1.26–0.11)	0.0199	−0.36	(−0.55–0.18)	0.0001	−0.36	(−0.54–0.17)	0.0001	−0.05	(−0.19–0.09)	0.4774
African-American	0.30	(−0.72–1.33)	0.5587	−0.69	(−0.99–0.39)	<.0001	−0.09	(−0.39–0.21)	0.5613	−0.31	(−0.54–0.08)	0.008
Hispanic	−0.35	(−1.31–0.6)	0.4649	0.17	(−0.13–0.47)	0.2616	0.09	(−0.22–0.39)	0.578	0.07	(−0.17–0.31)	0.5563
Other race	−0.46	(−1.4–0.49)	0.3442	−0.17	(−0.49–0.14)	0.284	−0.24	(−0.56–0.08)	0.141	−0.40	(−0.65–0.16)	0.0014
Married/Living with partner	−0.12	(−0.64–0.4)	0.6515	0.09	(−0.08–0.26)	0.295	0.08	(−0.09–0.25)	0.3698	−0.02	(−0.15–0.11)	0.7643
Highschool or less	−0.47	(−1.2–0.26)	0.2062	0.04	(−0.18–0.25)	0.7544	0.00	(−0.23–0.22)	0.9906	−0.06	(−0.23–0.11)	0.5245
Income: $25k to $50k	−0.34	(−1.08–0.4)	0.3645	0.02	(−0.22–0.27)	0.8605	−0.07	(−0.32–0.18)	0.595	0.10	(−0.09–0.29)	0.2886
Income: $50k to < $75k	−0.18	(−0.98–0.63)	0.6662	−0.06	(−0.32–0.2)	0.6479	−0.09	(−0.36–0.18)	0.5147	0.14	(−0.07–0.35)	0.2003
Income: $75k+	0.23	(−0.57–1.03)	0.5705	−0.23	(−0.49–0.03)	0.0808	−0.13	(−0.39–0.14)	0.3551	−0.08	(−0.29–0.13)	0.4622
Income: decline to answer	0.18	(−0.77–1.13)	0.7106	−0.70	(−1.03–0.37)	<.0001	−0.39	(−0.72–0.05)	0.0225	−0.14	(−0.39–0.12)	0.2904
Insurance	−0.19	(−1.63–1.25)	0.7927	−0.27	(−0.72–0.19)	0.2507	−0.11	(−0.55–0.34)	0.642	−0.20	(−0.55–0.15)	0.2706
Insurance with Rx coverage	−0.45	(−1.09–0.19)	0.1717	−0.08	(−0.3–0.14)	0.4799	−0.20	(−0.42–0.02)	0.0817	−0.16	(−0.33–0.01)	0.067
Diagnosed with Asthma	0.21	(−0.81–1.24)	0.6809	0.46	(0.14–0.79)	0.0051	0.33	(0.01–0.66)	0.044	0.23	(−0.02–0.47)	0.0714
Underweight	−2.58	(−5.05–0.1)	0.0414	−0.63	(−1.41–0.14)	0.1076	−0.83	(−1.59–0.06)	0.035	−0.40	(−0.97–0.17)	0.167
Overweight	-0.02	(−0.6–0.56)	0.944	−0.01	(−0.19–0.17)	0.9085	0.05	(−0.14–0.24)	0.6177	0.00	(−0.14–0.14)	0.9578
Obese	0.02	(−0.63–0.67)	0.9518	0.45	(0.25–0.65)	<.0001	0.40	(0.19–0.6)	0.0002	0.46	(0.31–0.61)	<.0001
Weight: decline to answer	−0.62	(−2.39–1.16)	0.4951	−0.80	(−1.41–0.19)	0.0099	−0.78	(−1.4–0.16)	0.0134	0.64	(0.16–1.12)	0.009
Charlson comorbidity index	0.29	(0.04–0.54)	0.0235	0.30	(0.22–0.38)	<.0001	0.28	(0.19–0.36)	<.0001	0.24	(0.17–0.3)	<.0001
Current smoker	−0.17	(−0.92–0.58)	0.6573	0.21	(−0.04–0.46)	0.1059	0.11	(−0.14–0.37)	0.3771	0.08	(−0.11–0.27)	0.4154
Former smoker	0.13	(−0.4–0.65)	0.6323	−0.08	(−0.25–0.08)	0.3156	−0.09	(−0.25–0.08)	0.3005	−0.09	(−0.21–0.04)	0.171
Diagnosed with COPD	0.99	(−0.03–2)	0.0562	0.37	(0.09–0.66)	0.0092	0.66	(0.36–0.95)	<.0001	0.56	(0.35–0.77)	<.0001

CI = confidence interval.