Reducing socioeconomic inequalities in COPD care in the hospital outpatient setting - A nationwide initiative

Tøttenborg, Sandra Søgaard; Lange, Peter; Thomsen, Reimar Wernich; Nielsen, Henrik; Johnsen, Søren P

doi:10.1016/j.rmed.2017.02.016

Cited by 4 publications

(2 citation statements)

References 18 publications

(27 reference statements)

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“…Research has shown that social disparities are best addressed by broad policies that may be beneficial not only for preventing COPD incidence but for decreasing health disparities for many other diseases and for all social strata ( Wilkinson & Pickett, 2009 ). A systematic quality improvement initiative in Denmark eliminated socioeconomic differences in COPD care during four years ( Tottenborg, Lange, Thomsen, Nielsen & Johnsen, 2017 ). In contrast, the privatizations of primary health care that have taken place in Sweden allocate health resources to affluent individuals ( Burstrom et al 2017 ) with lower risk and may therefore exacerbate such disparities.…”

Section: Conclusion and Recommendationsmentioning

confidence: 99%

Chronic Obstructive Pulmonary Disease in Sweden: An intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy

Fisk

Mulinari

Wemrell

et al. 2018

SSM - Population Health

103

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Socioeconomic, ethnic and gender disparities in Chronic Obstructive Pulmonary Disease (COPD) risk are well established but no studies have applied multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) within an intersectional framework to study this outcome. We study individuals at the first level of analysis and combinations of multiple social and demographic categorizations (i.e., intersectional strata) at the second level of analysis. Here we used MAIHDA to assess to what extent individual differences in the propensity of developing COPD are at the intersectional strata level. We also used MAIHDA to determine the degree of similarity in COPD incidence of individuals in the same intersectional stratum. This leads to an improved understanding of risk heterogeneity and of the social dynamics driving socioeconomic and demographic disparities in COPD incidence. Using data from 2,445,501 residents in Sweden aged 45–65, we constructed 96 intersectional strata combining categories of age, gender, income, education, civil- and migration status. The incidences of COPD ranged from 0.02% for young, native males with high income and high education who cohabited to 0.98% for older native females with low income and low education who lived alone. We calculated the intra-class correlation coefficient (ICC) that informs on the discriminatory accuracy of the categorizations. In a model that conflated additive and interaction effects, the ICC was good (20.0%). In contrast, in a model that measured only interaction effects, the ICC was poor (1.1%) suggesting that most of the observed differences in COPD incidence across strata are due to the main effects of the categories used to construct the intersectional matrix while only a minor share of the differences are attributable to intersectional interactions. We found conclusive interaction effects. The intersectional MAIHDA approach offers improved information to guide public health policies in COPD prevention, and such policies should adopt an intersectional perspective.

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Section: Conclusion and Recommendationsmentioning

confidence: 99%

Chronic Obstructive Pulmonary Disease in Sweden: An intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy

Fisk

Mulinari

Wemrell

et al. 2018

SSM - Population Health

103

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show abstract

“…However, the existence of small sociodemographic disparities and even smaller county-level disparities means that interventions should be proportionately more intense among sociodemographic strata with higher average risk of discontinuation, and to a lesser extent in counties with increased risk of discontinuation. One example of an efficient universal intervention is presented by Tottenborg et al, 64 who showed how a systematic quality improvement initiative managed to eliminate socioeconomic inequalities in COPD health care. Such universal incentives should be initiated in sociodemographic strata and counties with higher risk of discontinuation.…”

Section: Implications and Conclusionmentioning

confidence: 99%

<p>Geographical and sociodemographic differences in discontinuation of medication for Chronic Obstructive Pulmonary Disease – A Cross-Classified Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA)</p>

Khalaf¹,

Fisk²,

Ekberg-Jansson³

et al. 2020

CLEP

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Background: While discontinuation of COPD maintenance medication is a known problem, the proportion of patients with discontinuation and its geographical and sociodemographic distribution are so far unknown in Sweden. Therefore, we analyse this question by applying an innovative approach called multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA). Patients and Methods: We analysed 49,019 patients categorized into 18 sociodemographic contexts and 21 counties of residence. All patients had a hospital COPD diagnosis and had been on inhaled maintenance medication during the 5 years before the study baseline in 2010. We defined "discontinuation" as the absolute lack of retrieval from a pharmacy of any inhaled maintenance medication during 2011. We performed a cross-classified MAIHDA and obtained the average proportion of discontinuation, as well as county and sociodemographic absolute risks, and compared them with a proposed benchmark value of 10%. We calculated the variance partition coefficient (VPC) and the area under the receiver operating characteristics curve (AUC) to quantify county and sociodemographic differences. To summarize the results, we used a framework with 15 scenarios defined by the size of the differences and the level of achievement in relation to the benchmark value. Results: Around 18% of COPD patients in Sweden discontinued maintenance medication, so the benchmark value was not achieved. There were very small county differences (VPC=0.35%, AUC=0.54). The sociodemographic differences were small (VPC=4.98%, AUC=0.57). Conclusion: Continuity of maintenance medication among COPD patients in Sweden could be improved by reducing the unjustifiably high prevalence of discontinuation. The very small county and small sociodemographic differences should motivate universal interventions across all counties and sociodemographic groups. Geographical analyses should be combined with sociodemographic analyses, and the cross-classified MAIHDA is an appropriate tool to assess health-care quality.

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Inequality in the Quality of Health Services: Wealth, Content of Care, and the Price of Antenatal Consultations in the Democratic Republic of Congo

Fink

Kandpal²,

Shapira³

2022

Economic Development and Cultural Change

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Reducing socioeconomic inequalities in COPD care in the hospital outpatient setting - A nationwide initiative

Abstract: A systematic quality improvement initiative including regular audits, knowledge sharing, and detailed disease-specific recommendations for care improvement may increase the overall quality of care and considerably modify the substantial socioeconomic inequalities in COPD management.

Cited by 4 publications

References 18 publications

Chronic Obstructive Pulmonary Disease in Sweden: An intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy

Chronic Obstructive Pulmonary Disease in Sweden: An intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy

<p>Geographical and sociodemographic differences in discontinuation of medication for Chronic Obstructive Pulmonary Disease – A Cross-Classified Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA)</p>

Inequality in the Quality of Health Services: Wealth, Content of Care, and the Price of Antenatal Consultations in the Democratic Republic of Congo

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