Temporal Trends Of Pharmacologic Therapies For Patients With Chronic Obstructive Pulmonary Disease In Alberta, Canada

Figures & data

Figure 1 Patient selection flowchart.

Table 1 Characteristics Of Studied Population

Variable	All Patients	Hospital Patients	Outpatient Patients	p
Patients, N	33,169	9,089	24,080
Females, n (%)	16,772 (50.6)	4,679 (51.5)	12,093 (50.2)	0.041
Age, in years, mean (SD)	66.1 (13.8)	72 (13.1)	63.8 (13.4)	<0.001
Age, in years, median (IQR)	66 (55–77)	73 (63–82)	63 (54–74)	<0.001
Age group, n (%)
35-59 years	11,652 (35.1)	1,739 (19.1)	9,913 (41.2)	<0.001
60-69 years	8,038 (24.2)	2,023 (22.3)	6,015 (25)
70-79 years	6,894 (20.8)	2,271 (25)	4,623 (19.2)
≥80 years	6,585 (19.9)	3,056 (33.6)	3,529 (14.7)
Urban residence, n (%)	24,203 (73)	7,110 (78.2)	17,093 (71)	<0.001
Household income ($, n, (%))
0-40,000	451 (1.4)	145 (1.6)	306 (1.3)	<0.001
40,000–60,000	4,905 (14.8)	1,528 (16.8)	3,377 (14)
60,000–80,000	18,076 (54.5)	4,842 (53.3)	13,234 (55)
80,000–100,000	6,119 (18.5)	1,587 (17.5)	4,532 (18.8)
>100,000	3,618 (10.9)	987 (10.9)	2,631 (10.9)
Comorbidities, n (%)
Myocardial infarction	1,538 (4.6)	692 (7.6)	846 (3.5)	<0.001
Heart failure	3,474 (10.5)	1,901 (20.9)	1,573 (6.5)	<0.001
Peripheral vascular disease	913 (2.8)	400 (4.4)	513 (2.1)	<0.001
Cerebrovascular disease	1,162 (3.5)	456 (5)	706 (2.9)	<0.001
Dementia	1,084 (3.3)	671 (7.4)	413 (1.7)	<0.001
Rheumatoid disease	596 (1.8)	223 (2.5)	373 (1.6)	<0.001
Peptic ulcer	488 (1.5)	170 (1.9)	318 (1.3)	<0.001
Liver disease	619 (1.9)	245 (2.7)	374 (1.6)	<0.001
Diabetes	6,039 (18.2)	2,331 (25.7)	3,708 (15.4)	<0.001
Hemiplegia or paraplegia	215 (0.7)	100 (1.1)	115 (0.5)	<0.001
Renal disease	1,253 (3.8)	675 (7.4)	578 (2.4)	<0.001
Cancer	1,706 (5.1)	743 (8.2)	963 (4)	<0.001
Metastatic cancer	510 (1.5)	217 (2.4)	293 (1.1)	<0.001
Charlson comorbidity score, mean (SD)	1.9 (1.7)	2.6 (2)	1.7 (1.5)	<0.001
Follow-up time, month, median (SD)	44.1 (25.7)	40.2 (25.8)	45.6 (25.4)	<0.001

Abbreviations: IQR, interquartile range; SD, standard deviation.

Table 2 Drug Utilization Within 30 Days After Incident Event For Patients With COPD In Alberta, 2010–2016

Group	All	2010	2011	2012	2013	2014	2015	2016
Patient, N	33,169	4,292	4,464	4,845	4,621	5,228	4,900	4,819
Patient without drug, n (%)	14,503 (43.7)	2,030 (47.3)	1,937 (43.4)	2,106 (43.5)	1,941 (42)	2,311 (44.2)	2,088 (42.6)	2,090 (43.4)
Hospital, n (%)	3,329 (36.6)	548 (43.3)	526 (37.8)	539 (37.2)	446 (35.5)	480 (35.2)	404 (33.9)	386 (33)
Outpatient, n (%)	11,174 (46.4)	1,482 (49)	1,411 (45.9)	1,567 (46.1)	1,495 (44.4)	1,831 (47.4)	1,684 (45.4)	1,704 (46.7)
Patient with drug, n (%)	18,666 (56.3)	2,262 (52.7)	2,527 (56.6)	2,739 (56.5)	2,680 (58)	2,917 (55.8)	2,812 (57.4)	2,729 (56.6)
Hospital, n (%)	5,760 (63.4)	719 (56.7)	865 (62.2)	909 (62.8)	811 (64.5)	884 (64.8)	789 (66.1)	783 (67)
Outpatient, n (%)	12,906 (53.6)	1,543 (51)	1,662 (54.1)	1,830 (53.9)	1,869 (55.6)	2,033 (52.6)	2,023 (54.6)	1,946 (53.3)
SABA, n (%)	11,288 (60.5)	1,366 (60.4)	1,520 (60.2)	1,674 (61.1)	1,602 (59.8)	1,750 (60)	1,692 (60.2)	1,684 (61.7)
Hospital, n (%)	3,646 (63.3)	430 (59.8)	539 (62.3)	571 (62.8)	485 (59.8)	556 (62.9)	526 (66.7)	539 (68.8)
Outpatient, n (%)	7,642 (59.2)	936 (60.7)	981 (59)	1,103 (60.3)	1,117 (59.8)	1,194 (58.7)	1,166 (57.6)	1,145 (58.8)
SAMA, n (%)	2,659 (14.3)	320 (14.1)	311 (12.3)	399 (14.6)	391 (14.6)	407 (14)	404 (14.4)	427 (15.6)
Hospital, n (%)	1,064 (18.5)	139 (19.3)	132 (15.3)	152 (16.7)	157 (19.4)	164 (18.6)	162 (20.5)	158 (20.2)
Outpatient, n (%)	1,595 (12.4)	181 (11.7)	179 (10.8)	247 (13.5)	234 (12.5)	243 (12)	242 (12)	269 (13.8)
SABA/SAMA, n (%)	243 (1.3)	26 (1.1)	39 (1.5)	39 (1.4)	31 (1.2)	26 (0.9)	38 (1.4)	44 (1.6)
Hospital, n (%)	95 (1.7)	6 (0.8)	16 (1.9)	13 (1.4)	18 (2.2)	10 (1.1)	19 (2.4)	13 (1.7)
Outpatient, n (%)	148 (1.2)	20 (1.3)	23 (1.4)	26 (1.4)	13 (0.7)	16 (0.8)	19 (0.9)	31 (1.6)
LABA, n (%)	197 (1.1)	16 (0.7)	19 (0.8)	11 (0.4)	16 (0.6)	50 (1.7)	43 (1.5)	42 (1.5)
Hospital, n (%)	80 (1.4)	9 (1.3)	7 (0.8)	5 (0.6)	8 (1)	17 (1.9)	17 (2.2)	17 (2.2)
Outpatient, n (%)	117 (0.9)	7 (0.5)	12 (0.7)	6 (0.3)	8 (0.4)	33 (1.6)	26 (1.3)	25 (1.3)
LAMA, n (%)	5,704 (30.6)	672 (29.7)	775 (30.7)	856 (31.3)	764 (28.5)	955 (32.7)	871 (31)	811 (29.7)
Hospital, n (%)	3,024 (52.5)	364 (50.6)	454 (52.5)	505 (55.6)	410 (50.6)	497 (56.2)	403 (51.1)	391 (49.9)
Outpatient, n (%)	2,680 (20.8)	308 (20)	321 (19.3)	351 (19.2)	354 (18.9)	458 (22.5)	468 (23.1)	420 (21.6)
LABA/LAMA, n (%)	135 (0.7)	0 (0)	0 (0)	0 (0)	0 (0)	9 (0.3)	46 (1.6)	80 (2.9)
Hospital, n (%)	29 (0.5)	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)	4 (0.5)	25 (3.2)
Outpatient, n (%)	106 (0.8)	0 (0)	0 (0)	0 (0)	0 (0)	9 (0.4)	42 (2.1)	55 (2.8)
LABA/ICS, n (%)	7,769 (41.6)	961 (42.5)	1,113 (44)	1,195 (43.6)	1,152 (43)	1,218 (41.8)	1,150 (40.9)	980 (35.9)
Hospital, n (%)	2,801 (48.6)	357 (49.7)	427 (49.4)	474 (52.2)	404 (49.8)	432 (48.9)	375 (47.5)	332 (42.4)
Outpatient, n (%)	4,968 (38.5)	604 (39.1)	686 (41.3)	721 (39.4)	748 (40)	786 (38.7)	775 (38.3)	648 (33.3)
ICS, n (%)	3,031 (16.2)	411 (18.2)	404 (16)	473 (17.3)	423 (15.8)	465 (15.9)	413 (14.7)	442 (16.2)
Hospital, n (%)	575 (10)	87 (12.1)	89 (10.3)	97 (10.7)	72 (8.9)	88 (10)	62 (7.9)	80 (10.2)
Outpatient, n (%)	2,456 (19)	324 (21)	315 (19)	376 (20.6)	351 (18.8)	377 (18.5)	351 (17.4)	362 (18.6)
Methylxanthines, n (%)	37 (0.2)	9 (0.4)	12 (0.5)	7 (0.3)	3 (0.1)	4 (0.1)	0 (0)	2 (0.1)
Hospital, n (%)	14 (0.2)	3 (0.4)	5 (0.6)	2 (0.2)	2 (0.3)	1 (0.1)	0 (0)	1 (0.1)
Outpatient, n (%)	23 (0.2)	6 (0.4)	7 (0.4)	5 (0.3)	1 (0.1)	3 (0.2)	0 (0)	1 (0.1)
PDE4 inhibitors, n (%)	11 (0.1)	0 (0)	3 (0.1)	1 (0)	1 (0)	2 (0.1)	2 (0.1)	2 (0.1)
Hospital, n (%)	4 (0.1)	0 (0)	2 (0.2)	1 (0.1)	0 (0)	0 (0)	1 (0.1)	0 (0)
Outpatient, n (%)	7 (0.1)	0 (0)	1 (0.1)	0 (0)	1 (0.1)	2 (0.1)	1 (0.1)	2 (0.1)

Abbreviations: COPD, chronic obstructive pulmonary disease; ICS, inhaled corticosteroids; LABA, long-acting β-agonist; LABA/ICS, combination LABA/ICS in one device; LABA/LAMA, combination LABA/LAMA in one device; LAMA, long-acting muscarinic antagonist; PDE4 inhibitors, phosphodiesterase-4 inhibitors; SABA, short-acting β-agonist; SABA/SAMA, combination SABA/SAMA in one device; SAMA, short-acting muscarinic antagonist.

Table 3 COPD Drug Utilization Over Time After Incident Event In Alberta, 2010–2016

Group	Time From Incident Event
	Year 1	Year 2	Year 3	Year 4	Year 5
Patient, N	33,169	30,314	24,444	19,071	13,953
Patient without drug, n (%)	7,838 (23.6)	12,217 (40.3)	10,106 (41.3)	7,902 (41.4)	5,878 (42.1)
Patient with drug, n (%)	25,331 (76.4)	18,097 (59.7)	14,338 (58.7)	11,169 (58.6)	8,075 (57.9)
SABA, n (%)	18,607 (73.5)	11,952 (66)	9,625 (67.1)	7,486 (67)	5,542 (68.6)
SAMA, n (%)	4,535 (17.9)	2,231 (12.3)	1,752 (12.2)	1,383 (12.4)	1,083 (13.4)
SABA/SAMA, n (%)	526 (2.1)	325 (1.8)	287 (2)	223 (2)	196 (2.4)
LABA, n (%)	557 (2.2)	404 (2.2)	302 (2.1)	248 (2.2)	184 (2.3)
LAMA, n (%)	10,207 (40.3)	7,387 (40.8)	6,100 (42.5)	4,895 (43.8)	3,690 (45.7)
LABA/LAMA, n (%)	526 (2.1)	579 (3.2)	492 (3.4)	406 (3.6)	353 (4.4)
LABA/ICS, n (%)	14,997 (59.2)	10,576 (58.4)	8,549 (59.6)	6,611 (59.2)	4,810 (59.6)
ICS, n (%)	7,324 (28.9)	5,069 (28)	3,887 (27.1)	3,085 (27.6)	2,180 (27)
Methylxanthines, n (%)	98 (0.4)	80 (0.4)	78 (0.5)	56 (0.5)	45 (0.6)
PDE4 inhibitors, n (%)	72 (0.3)	83 (0.5)	55 (0.4)	56 (0.5)	44 (0.5)

Abbreviations: COPD, chronic obstructive pulmonary disease; ICS, inhaled corticosteroids; LABA, long-acting β-agonist; LABA/ICS, combination LABA/ICS in one device; LABA/LAMA, combination LABA/LAMA in one device; LAMA, long-acting muscarinic antagonist; PDE4 inhibitors, phosphodiesterase-4 inhibitors; SABA, short-acting β-agonist; SABA/SAMA, combination SABA/SAMA in one device; SAMA, short-acting muscarinic antagonist.

Figure 2 Initiation of key drug group for COPD patients.

Figure 3 Drug adherence for COPD patients.