Geographical and sociodemographic differences in discontinuation of medication for Chronic Obstructive Pulmonary Disease – A Cross-Classified Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA)

Figures & data

Figure 1 Flowchart indicating the selection of patients in the study sample.

Table 1 Framework for Evaluating Continuity of Maintenance Medication Among COPD Patients

Size of the County/Sociodemographic Differences			Benchmark Value Achievement
			Full	Close	Insufficient
	(%)		<10%	10–15%	>15%
Absent/very small	0–1	0.50–0.55	A	B	C
Small	1–5	0.55–0.61	D	E	F
Moderate	5–10	0.61–0.66	G	H	I
Large	10–20	0.66–0.72	J	K	L
Very large	>20	>0.72	M	N	O

Notes: The table outlines a two-dimensional evaluation of continuity with maintenance medication. First, we locate the overall achievement in relation to a predefined benchmark value. Second, we quantify the size of county and sociodemographic differences expressed as variance partition coefficient (VPC) and area under the receiver operating characteristics curve (AUC). Combining this information, we obtain 15 different scenarios (A–O) useful to the evaluation.

Table 2 Characteristics by County

County	Number of Patients	AR-D Crude (%)	AR-D Adjusted^a (%)	Female (%)	Mean Age (Years)	Income Group (%)
						High	Middle	Low
Stockholms län	10,028	21.01	25.80	57.14	67.50	31.46	36.35	32.19
Uppsala län	1699	16.48	20.77	54.97	67.25	22.66	37.08	40.26
Södermanlands län	1604	16.77	21.21	56.80	67.76	21.32	37.66	41.02
Östergötlands län	2264	15.28	19.73	55.30	67.72	20.32	36.75	42.93
Jönköpings län	1759	15.86	20.31	53.21	67.96	18.65	38.26	43.09
Kronobergs län	909	16.17	20.93	53.91	68.07	19.47	40.26	40.26
Kalmar län	1330	17.74	21.94	53.83	67.88	17.74	36.54	45.71
Gotlands län	331	20.24	22.74	50.45	67.35	13.90	34.44	51.66
Blekinge län	850	18.12	22.09	53.06	67.76	17.06	41.06	41.,88
Skåne län	8034	17.70	21.84	56.97	67.28	21.55	35.69	42.77
Hallands län	1523	16.41	21.17	55.88	68.31	24.43	37.16	38.41
Västra Götalands län	7567	19.65	24.21	57.31	68.11	19.41	36.91	43.68
Värmlands län	1161	13.87	19.15	53.66	68.57	15.93	33.76	50.30
Örebro län	1597	17.41	21.36	54.16	67.17	16.91	35.82	47.28
Västmanlands län	1324	18.88	22.67	56.34	67.19	18.96	38.44	42.60
Dalarnas län	1394	17.29	21.60	55.24	67.97	16.43	39.38	44.19
Gävleborgs län	1358	17.82	22.12	57.73	68.22	17.45	36.16	46.39
Västernorrlands län	1083	16.99	21.35	56.14	67.85	19.85	34.44	45.71
Jämtlands län	602	18.44	22.54	58.80	68.26	16.94	37.38	45.68
Västerbottens län	1150	18.00	22.39	57.83	68.70	17.48	39.91	42.61
Norrbottens län	1452	19.28	23.54	55.65	68.44	19.70	41.18	39.12
Sweden	49,019	18.36	21.86	56.25	67.75	22.08	36.91	41.01

Notes: Characteristics of the 49,019 COPD patients by county of residence and sociodemographic factors, as well as absolute risk for discontinuation (AR-D) of inhaled maintenance medication in 2011. Values are percentages if not otherwise indicated. ^aEstimated from the cross-classified MAIHDA.

Table 3 Number of Patients and Absolute Risk of Discontinuation by Sociodemographic Category

Sociodemographic Group	Number of Patients (N)	AR-D Crude (%)	AR-D Adjusted^a (%)
65–80 male high	3530	17.65	16.71
65–80 male middle	5913	17.74	17.07
65–80 male low	5731	18.79	18.22
50–64 male high	1528	21.53	20.59
50–64 male middle	1831	24.30	23.39
50–64 male low	2288	26.79	25.61
35–49 male high	115	29.57	26.54
35–49 male middle	161	34.78	31.58
35–49 male low	347	36.60	34.05
65–80 female high	3555	14.74	13.81
65–80 female middle	7070	15.30	14.56
65–80 female low	7813	15.33	14.85
50–64 female high	2026	15.20	14.55
50–64 female middle	2904	17.84	17.24
50–64 female low	3091	21.51	20.72
35–49 female high	68	23.53	21.79
35–49 female middle	214	32.24	29.58
35–49 female low	834	31.77	30.46
Total	49,019	18.36	21.86

Notes: Number of patients by sociodemographic group, as well as crude and adjusted absolute risk for discontinuation (AR-D) of inhaled maintenance medication in 2011. Values are percentages if not otherwise indicated. ^aEstimated from the cross-classified MAIHDA.

Table 4 Results (95% Confidence Intervals) from the Multilevel Cross-Classified Analysis of County and Sociodemographic Context in Relation to Discontinuation of Inhaled Maintenance Medication in 2011, Among 49,019 Patients with COPD

Variance
County level	0.012 (0.005–0.026)
Sociodemographic category	0.174 (0.082–0.352)
VPC (%)
County level	0.35 (0.15–0.75)
Sociodemographic context	4.98 (2.42–9.63)
AUC
County level (	0.54 (0.53–0.54)
Sociodemographic context	0.57 (0.56–0.57)

Abbreviations: VPC, variance partition coefficient; AUC, area under the receiver operating characteristics curve.

Figure 2 Adjusted absolute risk differences by county. Adjusted differences between the 21 counties in discontinuation of inhaled maintenance medication among 49,019 COPD patients according to the cross-classified multilevel model.

Figure 3 Adjusted absolute risk differences by sociodemographic category. Adjusted differences between the 18 sociodemographic categories in discontinuation of inhaled maintenance medication among 49,019 COPD patients according the cross-classified multilevel model.

Figure 4 Area under the receiver operating characteristics curve (AUC) for the county and for the sociodemographic information as predictors of discontinuation of inhaled maintenance medication among COPD patients in Sweden with previous maintenance treatment.