Factors Associated with Patient Education in Patients with Chronic Obstructive Pulmonary Disease (COPD) – A Primary Health Care Register-Based Study

Figures & data

Table 1 Overview of Registers, Year of Extracted Variables

Register	Swedish National Airway Register (SNAR)		National Patient Register (NPR)	Statistics Sweden (LISA)	Swedish Prescribed Drug Register (SPDR) Dispensed Medication/ATC Codes
Year	LOCF 2014–2019	2019, and LOCF, last 24-month period	2018–2019	2019	2019
Variables	Patient education Smoking status Smoking cessation support	Sex Age BMI FEV1% predicted CAT mMRC Written treatment plan Depression/anxiety Diabetes CVD	COPD hospitalization (ICD-10 J44 main diagnosis)	Educational level	Inhalation treatment Corticosteroids Depression Diabetes CVD	R03AC02-03 (SABA), R03BB01 (SAMA), R03AC12,13,18,19 (LABA), R03BB04-07 (LAMA), R03BA (ICS), R03AL03-07 (LABA/LAMA), R03AK (ICS/LABA), R03AL08,09, 11,12 (ICS/LABA/LAMA) H02AB01,02,06,07 N06 A10A, A10B C01–03, C08

Abbreviations: ATC, Anatomical Therapeutic Chemical; BMI, body mass index; CAT, COPD Assessment Test; CVD, cardiovascular disease; FEV₁, forced expiratory volume in 1 second; ICD-10, International Statistical Classification of Diseases and Related Health Problems, 10^th revision; LISA, longitudinal integrated database for health insurance and labour market studies; LOCF, last observation carried forward; mMRC, modified (British) Medical Research Council dyspnoea score.

Table 2 Characteristics of All Patients with Chronic Obstructive Pulmonary Disease (COPD), by COPD Patients Having Received and Not Having Received Patient Education

	All Patients n=29,692	Patient Education n=13,081 (44%)	No Patient Education n=16,611 (56%)	p-value
Basic characteristics
Women, n (%)	16,574 (56)	7377 (56)	9197 (55)	0.077
Age, yrs, mean (SD)	73 (9)	72 (9)	73 (10)	<0.001
Patients with BMI data, n (%)	26,261 (88)	12,647 (97)	13,614 (82)	<0.001
BMI (kg/m^2), mean (SD)	27 (6)	27 (6)	27 (6)	0.163
BMI <22	5292 (20)	2513 (20)	2779 (20)	0.274
Patients with educational level data, n (%)	29,292 (99)	12,939 (99)	16,353 (98)	<0.001
Primary school, n (%)	10,340 (35)	4488 (35)	5852 (36)	0.006
Secondary school, n (%)	13,657 (47)	6167 (48)	7490 (46)
Tertiary school, n (%)	5295 (18)	2284 (18)	3011 (18)
Patients with smoking status data, n (%)	26,545 (89)	12,791 (98)	13,754 (83)	<0.001
Never smoker, n (%)	4168 (16)	1380 (11)	2788 (20)	<0.001
Ex-smoker, n (%)	11,729 (44)	6399 (50)	5330 (39)
Current smoker, n (%)	10,649 (40)	5013 (39)	5636 (41)
COPD characteristics
Patients with FEV1 data, n (%)	17,844 (60)	10,678 (82)	7166 (43)	<0.001
FEV1% predicted, mean (SD)	60 (17)	59 (17)	62 (17)	<0.001
GOLD 1, n (%)	2486 (14)	1312 (12)	1174 (16)	<0.001
GOLD 2, n (%)	10,408 (58)	6215 (58)	4193 (59)
GOLD 3, n (%)	4247 (24)	2673 (25)	1574 (22)
GOLD 4, n (%)	703 (4)	478 (5)	225 (3)
Patients with CAT data, n (%)	18,523 (62)	11,327 (87)	7196 (43)	<0.001
CAT score, mean (SD)	13 (7)	13 (6)	13 (7)	0.548
CAT score <10, n (%)	5854 (32)	3577 (32)	2277 (32)	0.665
CAT score ≥20, n (%)	3376 (18)	2043 (18)	1333 (19)
Patients with data on GOLD groups A, B, E, n (%)	19,442 (66)	11,708 (90)	7734 (47)	<0.001
GOLD A, n (%)	5903 (30)	3492 (30)	2411 (31)	<0.001
GOLD B, n (%)	10,785 (56)	6484 (55)	4301 (56)
GOLD E, n (%)	2754 (14)	1732 (15)	1022 (13)

Notes: Where data were missing, percentages were calculated for reported data for each variable. Missing values: BMI, n=3431; CAT, n=11,169; educational level, n=400; FEV₁, n=11,848; GOLD A, B, E, n=10,250; smoking, n=3147.

Abbreviations: BMI, body mass index; CAT, COPD Assessment Test; FEV_1, forced expiratory volume in 1 second; GOLD, Global Initiative for Chronic Obstructive Lung Disease; SD, standard deviation.

Figure 1 Comorbidities in patients with chronic obstructive pulmonary disease (COPD). Comparison between patients having received and patients not having received patient education. Data on comorbidity derived from the Swedish Prescribed Drug Register (SPDR) and the Swedish National Airway Register (SNAR) are given separately.

Abbreviation: CVD, cardiovascular disease.

Table 3 Inhalation and Non-Pharmacological Treatment of All Patients with Chronic Obstructive Pulmonary Disease (COPD), by COPD Patients Having and Not Having Received Patient Education

	All Patients n=29,692	Patient Education n=13,081 (44%)	No Patient Education n=16,611 (56%)	p-value
Inhalation treatment
No inhalation treatment, n (%)	4185 (14)	1254 (10)	2931 (18)	<0.001
SABA or SAMA only, n (%)	1440 (5)	565 (4)	875 (5)	<0.001
LAMA, n (%)	5922 (20)	2642 (20)	3280 (20)	0.334
LABA, n (%)	795 (3)	306 (2)	489 (3)	0.001
ICS, n (%)	682 (2)	196 (2)	486 (3)	<0.001
LAMA/LABA, n (%)	5304 (18)	2834 (22)	2470 (15)	<0.001
ICS/LAMA, n (%)	539 (2)	215 (2)	324 (2)	0.049
ICS/LABA, n (%)	2335 (8)	799 (6)	1536 (9)	<0.001
ICS/LAMA/LABA, n (%)	8490 (29)	4270 (33)	4220 (25)	<0.001
Non-pharmacological treatment
Written treatment plan, n (%)	2527 (9)	2095 (16)	432 (3)	0.893
Offered smoking cessation support, n (%)	6176 (58)	3984 (80)	2192 (39)	<0.001

Abbreviations: ICS, inhaled corticosteroid; LABA, long-acting Beta-2 receptor agonist; LAMA, long-acting muscarinic receptor antagonist; SABA, short-acting Beta-2 receptor agonist; SAMA, short-acting muscarinic receptor antagonist.

Table 4 Adjusted Logistic Regression Analysis with Patient Education as the Dependent Variable

	OR (95% CI) Adjusted
Male	Ref.
Female	1.05 (1.00–1.11)
Age	1.00 (1.00–1.00)
GOLD 1	Ref.
GOLD 2	1.29 (1.18–1.42)
GOLD 3	1.41 (1.27–1.57)
GOLD 4	1.79 (1.48–2.15)
Missing: GOLD grades 1–4	0.55 (0.50–0.61)
GOLD A	Ref.
GOLD B	1.04 (0.97–1.11)
GOLD E	1.17 (1.06–1.29)
Missing: GOLD group A, B, E	0.21 (0.19–0.23)
Never smoker	Ref.
Ex-smoker	1.70 (1.56–1.84)
Current smoker	1.45 (1.33–1.58)
Missing: smoking status	0.40 (0.35–0.47)
Primary school	Ref.
Secondary school	1.01 (0.96–1.08)
Tertiary school	0.96 (0.89–1.04)
Missing: educational level	0.96 (0.75–1.23)
Cardiovascular disease	0.92 (0.87–0.98)
Diabetes	0.93 (0.87–1.00)
Depression/anxiety	1.01 (0.95–1.08)

Notes: Significant associations are given in bold.

Abbreviations: BMI, body mass index; CI, confidence interval; GOLD, Global Initiative for Chronic Obstructive Lung Disease; OR, odds ratio.