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

Figures & data

Table 1 Baseline characteristics by hospital site

Characteristics	Site A (n=190)	Site B (n=234)	Total (n=424)	p-value
Females:males	93:97	109:125	202:222	0.628
Age (years)	72 (10)	74 (10)	73 (10)	0.078
COPD severity^Citation12	n=166	n=223	n=389
Moderate (II)	46 (27.7%)	53 (23.8%)	99 (25.4%)	–
Severe (III)	62 (37.3%)	97 (43.5%)	159 (40.9%)	–
Very severe (IV)	58 (34.9%)	73 (32.7%)	131 (33.7%)	0.450
Smoking status	n=186	n=233	n=419	–
Never	5 (2.7%)	13 (5.6%)	18 (4.3%)	–
Ex-smoker	144 (77.4%)	179 (76.8%)	323 (77.1%)	–
Current smoker	37 (19.9%)	41 (17.6%)	78 (18.6%)	0.315
Anthropometry	n=186	n=234	n=420	–
Weight (kg)	69.8 (20.2)	72.6 (18.1)	71.4 (19.1)	0.134
BMI (kg/m^2)	25.4 (6.7)	26.1 (6.0)	25.8 (6.3)	0.232
MUST risk cat^2,*
Low	136 (72%)	195 (83%)	331 (78%)	–
Medium + High	54 (28%)	39 (17%)	93 (22%)	0.004
Deprivation	n=190	n=234	n=424	–
IMD score	21.25 (12.4)	11.56 (7.4)	15.90 (11.1)	<0.001

Notes: Continuous variables are presented as mean (SD) and analyzed using ANOVA; categorical variables are presented as mean (%) and analyzed using chi-squared analysis; site A = inner-city hospital; site B = community hospital;

* MUST risk cat² = Low vs Medium + High “MUST” categories.

Abbreviations: BMI, body mass index; IMD, Index of Multiple Deprivation; MUST, Malnutrition Universal Screening Tool.

Table 2 Influence of deprivation (IMD score) on 1-year health care use (n=384)

1-year health care use per patient*	β-coefficient	SE	p-value
Number of emergency hospital admissions (n)a	0.022	0.007	0.001
Emergency length of hospital stay (days)b	0.139	0.062	0.026
Number of visits to accident and emergency department (n)c	0.006	0.005	0.243
Number of elective hospital admissions (n)d	−0.001	0.004	0.840
Elective admission length of hospital stay (days)e	0.116	0.036	0.001
Secondary care outpatient appointments (n)f	−0.069	0.019	<0.001

Notes: Multiple regression analysis adjusting for age, COPD severity, smoking status, and malnutrition risk (mean IMD score 15.74; SD 11.06; SE 0.56; range 1.88–57.05).

* Mean ± SE (admission, appointments, or length of hospital stay [in days]) per patient per year after adjustment for the confounding variables listed in the table:

a 0.615±0.072;

b 4.953±0.672;

c 0.365±0.055;

d 0.273±0.038;

e 1.180±0.383;

F 4.706±0.210.

Abbreviation: IMD, Index of Multiple Deprivation.

Table 3 Influence of deprivation (IMD score) on annual secondary care health care costs (£) (n=384)

Health care use costs	β-coefficient*	SE	p-value
Emergency admissionsa	57.16	25.6	0.026
Elective admissionsb	50.38	15.4	0.001
Emergency and elective admissionsc	107.54	29.78	<0.001
Accident and emergency departmentd	0.67	0.570	0.243
Secondary care outpatient appointmentse	−6.88	1.93	<0.001
Total costsf	101.35	29.96	0.001

Notes: Multiple regression analysis adjusting for age, COPD severity, malnutrition risk, and smoking status. The mean (±SE) costs after adjustment for the listed confounding variables were as follows:

a £2,030.78±275.69;

b £511.98±166.16;

c £2,542.77±320.70;

d £40.47±6.14;

e £465.89±20.79;

F £3,049.10±322.57.

* The β-coefficient represents the annual increase in cost (£, GBP) per patient per unit increase in IMD score (mean IMD score 15.74; SD 11.06; SE 0.56; 15.78 and range 1.88–57.05).

Abbreviations: IMD, Index of Multiple Deprivation; SE, standard error.

Figure 1 Cox regression analysis of 1-year survival according to tertiles of IMD score, with adjustment for age, COPD disease severity, smoking status, and malnutrition risk.

Notes: n=384; mean IMD score: 15.74 (SD 11.06; SE 0.56; 15.78) and range: 1.88–57.05; 1= least deprived tertile, 3= most deprived tertile (overall p=0.014). With tertile 3 (most deprived) as referent, HR (in comparison with tertile 1) =0.306, 95% CI 0.130–0.719. p=0.007; and HR (in comparison with tertile 2) =0.471, 95% CI 0.226–0.984, p=0.045.
Abbreviations: HR, hazard ratio; IMD, Index of Multiple Deprivation.

Global Initiative for Chronic Obstructive Lung DiseasePocket Guide to COPD Diagnosis, Management, and Prevention2017 Report. Available from: http://goldcopd.org/wp-content/uploads/2016/12/wms-GOLD-2017-Pocket-Guide.pdfAccessed March 30, 2018

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BlackDCInequalities in HealthLondonPenguin1980

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