Clinical Characteristics, Treatment Patterns and Economic Burden of COPD in Kyrgyzstan: A FRESH AIR Study

Figures & data

Table 1 Demographics of the Kyrgyz COPD Study Population (n=306)

Category	Mean (SD)	Sub-Group	Number/Distribution (%)
Age	62.1 (SD=11.2)	<50	42 (13.7)
		51–60	98 (32.0)
		61–70	96 (31.4)
		71–80	59 (19.3)
		>80	11 (3.6)
Sex		Male	188 (61.4)
		Female	118 (38.6)
Education		Primary/Secondary	15 (4.9)
		Above secondary	291 (95.1)
BMI (mean, SD)	26.9 (SD=5.2)	Male	26.1 (4.9)
		Female	28.1 (5.4)
Working status		Working	92 (30.1)
		Not-working	34 (11.1)
		Retired	180 (58.8)
Monthly income (mean, SD)	7192 (SD=6374) som		$85.1 (SD=75.4)
Having insurance (%)			304 (99.3)
Smoking status		Non smoker	165 (53.9)
		Ex-smoker	98 (32.0)
		Current smoker	43 (14.1)
Occupational risk factors		Yes	56 (18.3)
		No	250 (81.7)
Biomass exposure		Yes	218 (71.2)
		No	87 (28.5)

Table 2 Clinical and Functional Characteristics of COPD Patients in Kyrgyzstan

Category	Mean (SD)	Sub-Group	Number/Distribution (%)
FEV1% predicted	46 (12.8)	>80% (mild)	1 (0.3)
		80–50% (moderate)	85 (27.8)
		50–30% (severe)	182 (59.5)
		<30% (very severe)	38 (12.4)
Dyspnea (MRC score)	3.7 (0.9)	<1	4 (1.3)
		≥1, <2	32 (10.5)
		≥2, <3	63 (20.6)
		≥3, <4	147 (48.0)
		≥4	60 (19.6)
MRC groups		≥4 (High)	60 (19.6)
		<4 (Low)	246 (80.4)
CCQ total scores	2.0 (0.9)	<1	7 (2.3)
		≥1, <2	30 (9.8)
		≥2, <3	109 (35.6)
		≥3	160 (52.3)
Exacerbation rate			293 (95.8)
Severity on the basis of combined assessment of COPD		A	19 (6.3)
		B	67 (22.2)
		C	4 (1.3)
		D	212 (70.2)

Figure 1 FEV1% predicted in Kyrgyz COPD patients.

Figure 2 Comorbidities (%) in COPD patients in Kyrgyzstan, only co-morbidities that occurred in 10 or more patients shown.

Figure 3 Pharmacotherapy of COPD patients by GOLD classification.

Table 3 Healthcare Resource Use, Direct, and Indirect Costs per Kyrgyz COPD Patient per Year (n=306)

	Number of Units (Mean, SD)	Patients with Co-Payment per Unit (N, %)	Patient Co-Payment per Unit (Mean, (SD)	Annual Reimbursed Cost per Patient (Mean, SD)	Annual Co-Payment Costs per Patient (Mean, SD)	Total Annual Costs per Patient (Mean)	Annual Patient Income (Mean, SD)
Cost category
1. Medication	2.43 (2.1)	201 (71.5)	$17.9 (18.9)	$8.3 (8.8)	$43.5 (39.9)	$51.8
2. Diagnostics	8.9 (7.2)	197 (64.4)	$13.9 (15.8)	$10.8 (7.9)	$123.7 (113.8)	$134.5
3. Hospitalization (days)	10.1 (3.9)	145 (50.0)	$2.5 (6.2)	$84.1 (21.8)	$25.3 (24.2)	$109.4
4. GP visits	2.9 (3.6)	60 (19.6)	$7 (5.0)	$1.7 (2.3)	$20.3 (18.0)	$22
5. Specialist visits	1.2 (1.0)	41 (15.9)	$9.5 (19.9)	$2.4 (1.4)	$11.4 (20.3)	$13.8
Total cost per patient				$107.3	$224.2	$331.5	$1021.7 (905.5)

Table 4 Univariate and Multivariate Associations with High MRC

Variable	Univariate OR	p-value	Multivariate OR	p-value
High MRC
Age	OR 1.019, 95% CI 0.993–1.046	0.146	OR 1.014, 95% CI 0.983–1.045	0.392
Female sex	OR 1.078, 95% CI 0.605–1.920	0.799
Education
Primary /Secondary	Reference
Above secondary	OR 0.281, 95% CI 0.036–2.179	0.224	OR 0.257, 95% CI 0.0432–2.055	0.200
BMI	OR 1.043, 95% CI 0.990–1.098	0.111	OR 1.042, 95% CI 0.989–1.098	0.124
Working status
Working	Reference
Not working	OR 2.266, 95% CI 0.823–6.235	0.113	OR 2.051, 95% CI 0.718–5.855	0.180
Retired	OR 2.172, 95% CI 1.058–4.461	0.035	OR 1.721, 95% CI 0.752–3.938	0.198
Smoking status
Non-smoker	Reference
Ex-smoker	OR 0.780, 95% CI 0.410–1.482	0.447
Current smoker	OR 0.849, 95% CI 0.361–1.994	0.707
Occupational risk factors
Yes	OR 2.296, 95% CI 0.935–5.640	0.070	OR 1.566, 95% CI 0.600–4.089	0.360
No	Reference
Biomass exposure
Yes	OR 1.460, 95% CI 0.801–2.663	0.217	OR 1.401, 95% CI 0.757–2.595	0.283
No	Reference
FEV1
GOLD I–II	Reference
GOLD III	OR 1.681, 95% CI 0.810–3.490	0.163	OR 1.573, 95% CI 0.752–3.293	0.229
GOLD IV	OR 3.545, 95% CI 1.410–8.912	0.007	OR 3.625, 95% CI 1.417–9.271	0.007
Exacerbation	OR 1.357, 95% CI 0.293–6.293	0.696
Hypertension	OR 2.534, 95% CI 1.145–5.609	0.022	OR 2.599, 95% CI 1.154–5.855	0.021
Diabetes	OR 1.147, 95% CI 0.319–4.124	0.834
Heart disease	OR 0.889, 95% CI 0.240–3.293	0.861

Table 5 Univariate and Multivariate Associations with High Cost

Variable	Univariate OR	p-value	Multivariate OR	p-value
High cost
Age	OR 1.012, 95% CI 0.992–1.032	0.250
Female sex	OR 1.613, 95% CI 1.014–2.566	0.044	OR 1.357, 95% CI 0.831–2.215	0.223
Education
Primary/ Secondary	Reference
Above secondary	OR 0.662, 95% CI 0.230–1.908	0.445
BMI	OR 1.002, 95% CI 0.960–1.046	0.919
Working status
Working	Reference
Not working	OR 1.058, 95% CI 0.481–2.328	0.888
Retired	OR 1.361, 95% CI 0.822–2.252	0.231	OR 1.180, 95% CI 0.677–2.056	0.558
Smoking status
Non-smoker	Reference
Ex-smoker	OR 0.774, 95% CI 0.469–1.277	0.316
Current smoker	OR 0.761, 95% CI 0.388–1.491	0.426
Occupational risk factors
Yes	OR 0.578, 95% CI 0.320–1.045	0.069	OR 0.644, 95% CI 0.336–1.237	0.187
No	Reference
Biomass exposure
Yes	OR 0.977, 95% CI 0.594–1.607	0.928
No	Reference
FEV1
GOLD I–II	Reference
GOLD III	OR 1.095, 95% CI 0.655–1.829	0.730
GOLD IV	OR 1.048, 95% CI 0.488–2.248	0.905
Exacerbation	OR 13.114, 95% CI 1.683–102.160	0.014	OR 13.407, 95% CI 1.691–106.306	0.014
Hypertension	OR 1.786, 95% CI 1.055–3.024	0.031	OR 1.736, 95% CI 1.002–3.007	0.049
Diabetes	OR 0.871, 95% CI 0.327–2.319	0.782
Heart disease	OR 0.730, 95% CI 0.247–2.155	0.569
MRC	OR 1.090, 95% CI 0.857–1.387	0.481