Medication Use Patterns Associated with Spirometry in Diagnosing COPD

Figures & data

Table 1 Patient characteristics stratified by the probability of having had spirometry performed and use of spirometry

	Quintile 1 Spirometry			Quintile 2 Spirometry			Quintile 3 Spirometry			Quintile 4 Spirometry			Quintile 5 Spirometry
	Yes	No		Yes	No		Yes	No		Yes	No		Yes	No
N	2,487	13,744		3,807	12,427		4,898	11,336		6,218	10,012		7,566	8,667
Age			*			*						*			*
40-49	3.0	2.6		5.2	4.6		6.3	6.0		7.5	7.1		9.3	10.2
50-59	11.0	8.0		19.8	17.8		23.5	23.1		28.6	28.6		40.3	41.5
60-69	12.6	10.3		18.7	18.7		22.8	23.7		27.9	29.2		31.3	30.8
70-79	39.2	39.7		36.1	39.1		34.7	35.2		30.0	30.0		17.0	15.9
80+	34.2	39.3		20.2	19.8		12.8	12.0		6.0	5.1		2.2	1.7
Age, Mean (SD)	72.8 (10.4)	74.5 (10.0)	*	68.8 (11.3)	69.6 (11.1)	*	66.8 (11.0)	67.1 (11.0)	*	64.4 (10.4)	64.6 (10.2)		61.1 (9.3)	60.7 (9.2)	*
Marital status			*												*
Married	61.4	64.5		58.9	60.3		56.2	56.5		54.2	54.9		51.5	49.4
Not married	38.0	35.1		40.8	39.2		43.3	42.9		44.9	44.4		47.6	49.6
Unknown	0.5	0.3		0.3	0.4		0.5	0.6		1.0	0.7		0.9	1.0
Co-morbidities
Asthma	2.9	3.5		5.1	5.0		6.3	6.4		8.9	9.4		15.5	14.2	*
Diabetes mellitus	30.3	30.1		26.4	25.7		25.9	26.5		29.2	29.0		26.8	26.2
Hypertension	69.5	70.6		68.1	69.5		69.5	70.8		72.5	72.4		72.4	70.6	*
Depression	19.4	17.1	*	21.0	20.5		22.9	22.2		26.1	25.8		29.9	30.9
Mental health	14.3	12.8	*	14.8	13.9		14.4	14.5		16.1	15.5		17.6	17.9
Heart disease	44.3	45.5		40.2	40.5		39.3	40.4		41.7	39.5	*	36.8	37.3
Lung disease, other	0.6	0.5		1.0	0.8		1.4	1.2		2.1	1.7		3.2	3.5
Collagen vascular disease	1.9	1.5		1.7	1.9		2.3	2.1		2.4	2.5		3.2	3.4
Alcoholism	13.2	10.3	*	13.0	12.5		11.7	12.2		13.9	13.2		11.5	13.0	*
Substance abuse	5.8	5.0		5.7	5.8		5.5	4.9		6.5	5.7	*	5.5	6.5	*
Osteoarthritis	28.4	28.5		28.4	28.9		30.9	29.9		31.9	31.8		32.1	32.5
BPH	19.6	20.0		19.5	20.6		18.8	20.1		19.8	19.4		19.5	18.4
Cancer	18.5	16.5	*	21.5	21.3		22.8	23.7		27.4	27.2		32.2	32.6
Medication use
None	81.0	78.5	*	74.8	74.2		69.7	69.1		60.2	59.9		42.1	45.3	*
SABA	13.8	14.7		21.0	21.3		26.5	27.3		36.4	37.2		55.5	52.6	*
LABA	3.8	5.2	*	3.8	4.2		3.2	3.7		3.6	4.0		5.5	4.2	*
IPRA	8.6	9.7		12.4	13.2		16.0	16.2		21.1	21.1		30.4	28.7	*
ICS	6.3	8.2	*	7.0	7.7		6.6	7.9	*	8.8	8.9		13.7	11.9	*
Theo	1.3	1.6		0.8	1.0		0.8	0.9		0.8	0.8		1.0	0.7	*
Healthcare Utilization
Primary care			*									*			*
visit (number/year)
0	5.1	4.4		3.6	3.7		2.5	2.7		1.3	1.1		0.4	0.4
> 0 to 3	62.3	66.3		42.1	42.4		25.5	25.5		9.8	9.7		3.5	2.7
> 3 to6	23.9	23.		35.2	35.3		41.3	40.9		40.2	42.5		29.4	30.0
> 6	8.6	6.3		19.1	18.7		30.7	31.0		48.8	46.7		66.6	66.9
Pulmonary visit															*
(number/year)
0	0	0		0	0		99.9	100.0		99.9	100.0		97.5	98.9
> 0 to1	0	0		0	0		0.0	0.0		0.1	0.0		1.8	1.0
> 1 to 2	0	0		0	0		0.0	0.0		0.0	0.0		0.6	0.1
> 2	0	0		0	0		0	0		0	0		0.1	0.0
ED visit (number/year)			*			*
0	87.6	91.0		84.4	86.4		82.8	83.2		78.6	79.0		74.1	72.7
> 0 to1	6.9	5.0		9.8	9.0		11.2	10.9		14.7	14.4		19.0	19.6
> 1 to 2	3.0	2.4		3.2	2.8		3.6	3.4		3.8	3.8		.9	4.4
> 2	2.6	1.6		2.7	1.8		2.4	2.4		3.0	2.9		3.0	3.4
Hospitalization			*			*
(number/year)
0	74.1	79.2		72.7	75.4		73.5	73.5		69.3	69.7		68.9	67.6
> 0 to 1	16.9	13.5		19.9	17.9		20.4	19.9		23.8	24.0		26.3	27.3
> 1 to 2	4.9	4.0		4.9	4.0		3.9	4.5		5.1	4.5		3.7	4.1
> 2	4.2	3.3		2.6	2.6		2.1	2.2		1.8	1.9		1.0	1.1

*P-Value < 0.05. Data is presented as a percentage unless otherwise specified. BPH = benign prostatic hyperplasia; SABA = short-acting beta-agonist; LABA = long-acting beta-agonist; IPRA = ipratropium bromide; ICS = inhaled corticosteroids; Theo = theophylline; ED = emergency department. Other lung disease includes the following diagnosis: bronchiectasis, pulmonary hypertension, cor pulmonale, and/or pneumoconiosis.

Table 2 Patients receiving medications before and after the index date

Quintile	1	2	3	4	5	Overall
Prior to index date (%)
None	78.9	74.3	69.2	60.0	43.8	65.2
ICS	7.9	7.5	7.5	8.8	12.7	8.9
LABA	5.0	4.1	3.5	3.9	4.8	4.3
SABA	14.5	21.3	27.1	36.9	54.0	30.7
IPRA	9.5	13.0	16.1	21.1	29.5	17.8
After the index date (%)
None	57.4	53.6	50.4	46.2	36.8	48.9
ICS	13.8	14.2	14.2	15.5	20.3	15.6
LABA	9.1	9.0	8.8	9.05	11.1	9.4
SABA	35.8	40.9	44.7	49.6	59.2	46.0
IPRA	27.3	29.8	32.3	35.0	40.2	32.9

ICS = inhaled corticosteroids; LABA = long-acting beta-agonist; SABA = short-acting beta-agonist; IPRA = ipratropium bromide.

Figure 1 Adjusted odds ratios of medication use one year prior to (Pre) and after (Post) the index date for those who have ever had a spirometry 720 days prior to 180 days after the index date for quintiles one to five, from left to right. Quintile 1 is the group with the least probability of having spirometry. ICS = inhaled corticosteroid; LABA = long-acting beta agonist; SABA = short-actiing berta agonist; IPRA = ipratropium; Q = quintile. The logistic regression models (LRM) were adjusted for the following unbalanced covariates. Quintile one: age, marital status, depression, mental health, alcohol abuse, cancer, primary care, emergency department, and hospital contacts. Quintile two: age, emergency department and hospital contacts. Quintile three was balanced. Quintile four: age, heart disease, substance abuse, and primary care contacts. Quintile five: age, marital status, asthma, hypertension, alcohol abuse, substance abuse, primary care and pulmonary contacts. The LRM for medication use after the index date was also adjusted for medications prior to the index date if not balanced within the propensity scores quintiles. These included ICS, LABA and no medication use in quintile one, ICS in quintile three, and ICS, LABA, SABA, IPRA and no medication use in quintile five.

Figure 2 Adjusted odds ratios for adding (Add) and discontinuing (Drop) medications for those who have ever had a spirometry 720 days prior to 180 days after the index date for quintiles one to five, from left to right. Quintile 1 is the group with the least probability of having spirometry. ICS = inhaled corticosteroid; LABA = long-acting beta agonist; SABA = short-actiing beta agonist; IPRA = ipratropium; Q = quintile. The logistic regression models were adjusted for the unbalanced covariates. (Same as in Figure 1 except for medications).