Socioeconomic Variations in Use of Prescription Medicines for COPD: A Register-Based Study

Abstract

BACKGROUND: The purpose of this study was to examine socioeconomic variations in the use of prescription medicines among elderly subjects with COPD. METHODS: Data from the Danish national administrative registers were used. The study population included 1,365 individuals >60 y old residing in the Municipality of Copenhagen and diagnosed with COPD in a hospital setting in 2007. Logistic regression analysis was applied to examine the associations between the use of all prescription medicines for obstructive pulmonary diseases and the use of long-acting bronchodilators, in subject groups of different socioeconomic position. RESULTS: The study demonstrated that approximately 90% of subjects with COPD purchased at least one prescription medicine for obstructive pulmonary diseases, whereas approximately 50% purchased a long-acting bronchodilator. Medicine use did not vary according to educational status or personal wealth. CONCLUSIONS: There were no systematic socioeconomic differences in the use of relevant prescription medicines in elderly subjects diagnosed with COPD in hospital settings in Copenhagen. However, our findings indicate a gap between guideline recommendations and observed use of long-acting bronchodilators and hence suboptimal quality of treatment in the elderly COPD population.

Socioeconomic inequalities in adherence to inhaled maintenance medications and clinical prognosis of COPD

“…Our finding that lower income is associated with nonuse agrees with two previous studies [26,27]. A Danish registerbased study examining socioeconomic variations in use of maintenance medications in 1365 COPD patients >60 years old showing a lower risk of non-use among more affluent patients [26], and a US study showing lower use of LAMA among low-income COPD patients 55 years old (23). We also found lower income to be associated with poor adherence.…”

“…The authors did not have information on diagnosis status, but in a related study they observed a higher proportion of individuals with high education receiving no treatment the year leading up to baseline [25], which could be indicative of underdiagnosis. Our finding that lower income is associated with nonuse agrees with two previous studies [26,27]. A Danish registerbased study examining socioeconomic variations in use of maintenance medications in 1365 COPD patients >60 years old showing a lower risk of non-use among more affluent patients [26], and a US study showing lower use of LAMA among low-income COPD patients 55 years old (23).…”

“…Lastly, in regards to adherence, we observed that cohabitation status was associated with poor adherence and non-use in particular. Studies from other patient groups [8] as well as COPD patients [26,30,32] have reported married status to be associated with better adherence. Our findings of SES-related differences in clinical outcomes are in keeping with previous studies showing a higher risk of COPD health services utilization among individuals with lowest SES [1].…”

Factors influencing pharmacological treatment in COPD: a comparison of 2005 and 2014

“…Many patients received no treatment despite experiencing symptoms, and among those on treatment most received ICS irrespective of the severity of airflow limitation, asthma diagnosis, and exacerbation history. Several other studies have reported undertreatment with bronchodilators in comparison with ICS [9,13], or a majority of patients receiving LABA/ICS without LAMA [16]. Rather few studies have investigated temporal change in treatment patterns, but our results of decreased proportions of patients with sole ICS treatment or no maintenance treatment at all over time are consistent with a study of COPD patients in UK primary care [12].…”