Management of COPD, equal treatment across age, gender, and social situation? A register study

Figures & data

Table 1 Demographic and clinical characteristics at registration of the total sample and divided by age, gender, and social situation

Demographic variables	Total sample, N=7,810	Age			Gender			Social situation
		≤70 years n=4,303 (55.1%)	>70 years n=3,507 (44.9%)	P-value	Men n=3,448 (44.1%)	Women n=4,362 (55.9%)	P-value	Living alone n=1,934 (24.8%)	Cohabiting n=3,083 (39.5%)	P-value
Age, mean (SD)	69 (9.1)				70.1 (9.4)	68.5 (9.4)	<0.001	70.6 (9.6)	68.9 (9.0)	<0.001
Social situation, n (%)
Living alone	1,934 (38.5)	944 (35.0)	990 (42.6)	<0.001	644 (18.7)	1,290 (29.6)	<0.001
Cohabiting	3,083 (61.4)	1,749 (65.0)	1,334 (57.4)		1,647 (47.8)	1,436 (32.9)
Clinical variables	Mean (SD)	Mean (SD)	Mean (SD)		Mean (SD)	Mean (SD)		Mean (SD)	Mean (SD)
FEV1% of the predicted value	50.3 (20.1)	51.2 (22.1)	49.2 (17.1)	<0.001	50.6 (23.1)	50.0 (17.2)	0.236	47.6 (16.7)	50.4 (17.1)	<0.001
Exacerbations, last 12 months before registration	0.78 (1.4)	0.77 (1.3)	0.80 (1.5)	0.416	0.68 (1.3)	0.87 (1.5)	<0.001	0.83 (1.3)	0.78 (1.5)	0.257
Hospital admissions, last 12 months before registration	0.23 (0.8)	0.17 (0.6)	0.31 (1.0)	<0.001	0.21 (0.8)	0.26 (0.8)	0.010	0.33 (1.0)	0.23 (0.9)	<0.001
BMI	26.0 (5.6)	26.3 (5.9)	25.7 (5.2)	<0.001	26.3 (5.2)	25.8 (5.9)	<0.001	25.5 (5.7)	26.1 (5.3)	0.003
Comorbidity	n (%)	n (%)	n (%)		n (%)	n (%)		n (%)	n (%)
Heart failure	761 (9.7)	232 (5.4)	529 (15.1)	<0.001	409 (11.9)	352 (8.1)	<0.001	241 (12.5)	296 (9.6)	<0.001
Ischemic heart disease	1,199 (15.3)	481 (11.2)	718 (20.5)	<0.001	712 (20.6)	487 (11.2)	<0.001	312 (16.1)	472 (15.3)	0.060
Stroke	405 (5.2)	171 (4.0)	234 (6.7)	,0.001	231 (6.7)	174 (4.0)	,0.001	109 (5.6)	156 (5.1)	0.031
Hypertension	3,136 (40.2)	1,519 (35.3)	1,617 (46.1)	<0.001	1,403 (40.7)	1,733 (39.7)	0.387	771 (39.9)	1,254 (40.7)	0.815
Atrial fibrillation	600 (7.7)	179 (4.2)	421 (12.0)	<0.001	344 (10.0)	256 (5.9)	<0.001	154 (8.0)	251 (8.1)	0.372
Diabetes	894 (11.4)	446 (10.4)	448 (12.8)	0.001	481 (14.0)	413 (9.5)	<0.001	216 (11.2)	374 (12.1)	0.791
Osteoporosis	749 (9.6)	308 (7.2)	441 (12.6)	<0.001	124 (3.6)	625 (14.3)	<0.001	251 (13.0)	267 (8.7)	<0.001
Depression/anxiety	1,136 (14.5)	708 (16.5)	431 (12.3)	<0.001	327 (9.5)	812 (18.6)	<0.001	360 (18.6)	396 (12.8)	<0.001
α1-Antitrypsin deficit	46 (0.6)	34 (0.8)	12 (0.3)	0.016	14 (0.4)	32 (0.7)	0.067	13 (0.7)	15 (0.5)	0.552
Sleep apnea	141 (1.8)	100 (2.3)	41 (1.2)	<0.001	78 (2.3)	63 (1.4)	0.004	33 (62.3)	59 (1.9)	0.316
Patient-reported variables	n (%)	n (%)	n (%)		n (%)	n (%)		n (%)	n (%)
Smoking:				<0.001			0.497			0.050
Nonsmoker	295 (3.8)	77 (1.8)	218 (6.4)		89 (2.6)	206 (4.8)		67 (3.5)	94 (3.1)
Have quit smoking	4,648 (60.1)	2,274 (53.7)	2,374 (69.4)		2,156 (63.7)	2,492 (58.4)		1,101 (57.4)	2,014 (65.8)
Still smoking	2,706 (35.4)	1,880 (44.4)	826 (24.2)		1,140 (33.7)	1,566 (36.7)		749 (39.1)	952 (31.1)
	Mean (SD)	Mean (SD)	Mean (SD)		Mean (SD)	Mean (SD)		Mean (SD)	Mean (SD)
Exercise capacity (days per week)	3.3 (2.8)	3.5 (2.8)	3.0 (1.3)	,0.001	3.4 (2.8)	3.2 (2.8)	0.030	3.2 (2.8)	3.4 (2.8)	0.098
Functional dyspnea, (mMRC)	1.88 (1.2)	1.67 (1.2)	2.14 (1.3)	<0.001	1.84 (1.3)	1.91 (1.2)	0.028	2.13 (1.3)	1.80 (1.2)	<0.001
Quality of life (CCQ)	1.8 (1.2)	1.8 (1.2)	1.9 (1.1)	<0.001	1.8 (1.1)	1.8 (1.2)	0.782	2.0 (1.2)	1.8 (1.2)	<0.001

Notes: N=7,810. Some registrations were missed, which resulted in lower number of participants in some of the variables.

Abbreviations: BMI, body mass index; CCQ, Clinical COPD Questionnaire; FEV₁, forced expiratory volume in 1 second; mMRC, modified Medical Research Council; SD, standard deviation.

Table 2 Treatments at registration for the patients by age, gender, and social situation*

Treatments	Total sample n (%) (N=7,810)	Age			Gender			Social situation
		≤70 years n=4,303 (55.1%)	>70 years n=3,507 (44.9%)	P-value	Men n=3,448 (44.1%)	Women n=4,362 (55.9%)	P-value	Living alone n=1,934 (38.5%)	Cohabiting n=3,083 (61.4%)	P-value
		n (%)	n (%)		n (%)	n (%)		n (%)	n (%)
Still smokers (n=2,706)
Participated in SCP	924 (34.1)	713 (40.3)	211 (27.8)	<0.001	368 (34.7)	556 (37.8)	0.109	299 (41.8)	324 (35.9)	0.016
Participation in patient education program	1,725 (22.1)	962 (22.4)	763 (21.8)	0.977	687 (21.5)	1,038 (25.9)	<0.001	446 (24.8)	724 (24.8)	0.973
Contact with:
Physiotherapist	1,522 (19.5)	813 (18.9)	709 (20.2)	0.081	572 (17.3)	950 (22.8)	<0.001	485 (25.6)	592 (19.6)	<0.001
Dietician	843 (10.8)	416 (9.7)	427 (12.2)	<0.001	300 (9.1)	543 (13.0)	<0.001	307 (16.2)	334 (11.0)	<0.001
Occupational therapist	539 (6.9)	253 (5.9)	286 (8.2)	<0.001	184 (5.6)	355 (8.6)	<0.001	197 (10.6)	204 (6.8)	<0.001
Social worker	337 (4.3)	204 (4.7)	133 (3.8)	0.053	100 (3.1)	237 (5.8)	<0.001	120 (6.4)	123 (4.1)	<0.001
Vaccinated against:
Pneumococcus	2,978 (38.1)	1,456 (42.3)	1,522 (56.8)	<0.001	1,224 (45.5)	1,754 (51.1)	<0.001	796 (51.3)	1,242 (49.4)	0.248
Influenza	3,934 (50.4)	1,847 (52.9)	2,087 (71.7)	<0.001	1,706 (60.3)	2,228 (62.3)	0.097	1,006 (62.0)	1,712 (64.7)	0.075
Oxygen treatment at home	169 (2.2)	67 (1.6)	102 (3.0)	<0.001	61 (1.8)	108 (2.6)	0.030	56 (2.9)	77 (2.5)	0.401
Medication:
Long-acting anticholinergics	4,414 (56.5)	2,294 (54.9)	2,120 (62.6)	<0.001	1,887 (56.4)	2,527 (59.9)	0.002	1,188 (62.1)	1,760 (59.7)	0.003
Inhaled steroids	1,003 (12.8)	536 (12.9)	467 (13.8)	0.230	412 (12.3)	591 (14.1)	0.027	239 (12.5)	411 (13.5)	0.287
Combination of long-acting β2-Adrenoceptor agonists and inhaled steroids	3,860 (49.4)	2,007 (48.1)	1,853 (54.7)	<0.001	1,646 (49.3)	2,214 (52.5)	0.006	1,087 (56.7)	1,557 (51.1)	<0.001
N-acetylcysteine	2,014 (25.8)	1,005 (24.2)	1,009 (30.0)	<0.001	873 (26.2)	1,141 (27.2)	0.308	600 (31.4)	848 (27.9)	0.008
Calcium	882 (11.3)	395 (9.7)	487 (14.8)	<0.001	184 (5.6)	698 (17.0)	<0.001	306 (16.4)	341 (11.4)	<0.001
Bisphosphonate	422 (5.4)	186 (4.5)	236 (6.7)	<0.001	86 (2.6)	336 (8.2)	<0.001	132 (7.1)	175 (5.9)	0.078
β2-Adrenoceptor agonists long acting	1,079 (13.8)	545 (13.1)	534 (15.8)	<0.001	451 (13.5)	628 (15.0)	0.075	278 (14.6)	438 (14.4)	0.885

Note:

* Some registrations were missed, which resulted in lower number of participants in some of the variables.

Abbreviation: SCP, smoking cessation programs.

Table 3 Logistic binary regression analysis with nonpharmacological treatments, ie, participation in smoking cessation program or patient education, contact with dietician or physiotherapist

Independent variables	Smoking cessation program (only smokers)		Patient education program		Dietician		Physiotherapist
	Univariable	Multivariable	Univariable	Multivariable	Univariable	Multivariable	Univariable	Multivariable
	OR (95% CI), P-value	OR (95% CI), P-value	OR (95% CI), P-value	OR (95% CI), P-value	OR (95% CI), P-value	OR (95% CI), P-value	OR (95% CI), P-value	OR (95% CI), P-value
Constant		3.73, P=0.027		0.31*		0.77, P=0.768		0.57, P=0.20
Age, divided by 10 years	0.76 (0.69, 0.83)*	0.78 (0.66, 0.93), P=0.005	1.00 (0.94, 1.06), P=0.972		1.20 (1.11, 1.30)*		1.07 (1.00, 1.14), P=0.034
Gender (1= man, 2= woman)	1.14 (0.97, 1.35), P=0.109		1.28 (1.15, 1.43)*		1.50 (1.29, 1.74)*	1.40 (1.04, 1.88), P=0.028	1.41 (1.25, 1.58)*
Social situation (0= living alone, 1= cohabiting)	0.78 (0.64, 0.96), P=0.016	0.71 (0.52, 0.96), P=0.028	1.00 (0.88, 1.15), P=0.973		0.64 (0.54, 0.76)*		0.71 (0.62, 0.81)*	0.80 (0.64, 0.98) P=0.035
FEV1% of the predicted value	1.00 (0.99, 1.00), P=0.17		0.99 (0.98, 0.99)*	0.99 (0.99, 1.00), P=0.002	0.96 (0.95, 0.96)*	0.98 (0.97, 0.99)*	0.97 (0.96, 0.97)*	0.97 (0.97, 0.98)*
BMI	1.01 (1.00, 1.03), P=0.187		0.99 (0.98, 1.00), P=0.120		0.88 (0.87, 0.90)*	0.90 (0.87, 0.92)*	0.99 (0.98, 1.00), P=0.041
Exercise capacity	1.02 (0.99, 1.06), P=0.146		0.98 (0.96, 1.00), P=0.136		0.92 (0.89, 0.95)*		0.97 (0.94, 0.99), P=0.002
Quality of life (CCQ) (0–6)	1.14 (1.05, 1.24), P=0.002		1.18 (1.12, 1.25)*		1.72 (1.60, 1.83)*	1.36 (1.17, 1.59)*	1.46 (1.38, 1.54)*
Dyspnea (mMRC) (0–4)	1.11 (1.03, 1.19), P=0.006		1.23 (1.17, 1.28)*	1.17 (1.09, 1.26)*	1.88 (1.76, 1.00)*	1.47 (1.26, 1.72)*	1.58 (1.50, 1.66)*	1.32 (1.20, 1.44)*
Exacerbations per year	1.07 (1.00, 1.14), P=0.05		1.13 (1.08, 1.17)*	1.064 (1.01, 1.12), P=0.020	1.33 (1.27, 1.38)*	1.16 (1.07, 1.24)*	1.30 (1.25, 1.36)*	1.12 (1.06, 1.20)*
Test
Area under the curve		0.578		0.585		0.797		0.706

Note:

* P<0.001.

Abbreviations: BMI, body mass index; CCQ, Clinical COPD Questionnaire; CI, confidence interval; FEV₁, forced expiratory volume in 1 second; mMRC, modified Medical Research Council; OR, odds ratio.

Table 4 Logistic binary regression analysis with pharmacological treatments, ie, prescriptions of long-acting anticholinergics and a combination of steroids and long-acting β₂-adrenoceptor agonists as dependent variables

Independent variables	Prescription of long-acting anticholinergics		Prescription of a combination of long-acting β2-adrenoceptor agonists and inhaled steroids
	Univariable	Multivariable	Univariable	Multivariable
	OR (95% CI), P-value	OR (95% CI)	OR (95% CI), P-value	OR (95% CI)
Constant		1.61, P=0.008		1.58, P=0.007
Age, divided in 10 years	1.25 (1.19, 1.32)*		1.19 (1.13, 1.24)*
Gender (1= man, 2= woman)	1.16 (1.05, 1.27), P=0.002		1.14 (1.04, 1.24), P=0.006
Social situation (0= living alone, 1= cohabiting)	0.84 (0.74, 0.94), P=0.003		0.80 (0.71, 0.90)*
FEV1% of the predicted value	0.98 (0.97, 0.98)*	0.99 (0.98, 0.99)*	0.97 (0.97, 0.97)*	0.98 (0.97, 0.98)*
BMI	0.99 (0.98, 1.00), P=0.121		1.00 (0.99, 1.01), P=0.709
Exercise capacity	1.00 (0.98, 1.02), P=0.766		0.99 (0.97, 1.00), P=0.985
Quality of life (CCQ)	1.35 (1.28, 1.42)*		1.56 (1.48, 1.64)*	1.19 (1.09, 1.30)*
Dyspnea (mMRC)	1.46 (1.40, 1.52)*	1.30 (1.20, 1.40)*	1.56 (1.50, 1.63)*	1.22 (1.13, 1.33)*
Exacerbations per year	1.18 (1.13, 1.23)*	1.08 (1.01, 1.15), P=0.026	1.38 (1.32, 1.45)*	1.16 (1.08, 1.24)*
Test
Area under the curve		0.658		0.694

Note:

* P<0.001

Abbreviations: BMI, body mass index; CCQ, Clinical COPD Questionnaire; CI, confidence interval; FEV₁, forced expiratory volume in 1 second; mMRC, modified Medical Research Council; OR, odds ratio.