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Socioeconomic gradients in tiotropium use among adults with COPD.

Blanc PD, Eisner MD, Yelin EH, Earnest G, Balmes JR, Gregorich SE, Katz PP - Int J Chron Obstruct Pulmon Dis (2008)

Bottom Line: Among the subset with lung function data (n = 95), after including COPD Global Obstructive Lung Disease (GOLD) Stage > or = 2 in the model, lower SES remained associated with reduced odds oftiotropium use (OR 0.03; 95% CI < 0.001-0.7; p = 0.03).Including forced expiratory volume in one second in the model as a continuous variable instead of GOLD Stage > or = 2 yielded similar results for lower SES (OR 0.1; 95% CI < 0.001-0.5; p = 0.02).There was a strong SES gradient in tiotropium use such that there was less use with lower SES.

View Article: PubMed Central - PubMed

Affiliation: Division of Occupational and Environmental Medicine, Cardiovascular Research Institute, University of California San Francisco, San Francisco, CA 94143-0924, USA. paul.blanc@ucsf.edu

ABSTRACT

Background: Inequalities in the use of new medications may contribute to health disparities. We analyzed socioeconomic gradients in the use of tiotropium for chronic obstructive pulmonary disease (COPD).

Methods: In a cohort of adults with COPD aged > or = 55 years identified through population-based sampling, we elicited questionnaire responses on demographics, socioeconomic status (SES; lower SES defined as high school education or less or annual household income < US $20,000), and medication use and other clinical variables. In a subset we obtained pulmonary function testing. We used multiple logistic regression analysis to estimate the associations between SES and tiotropium use in COPD, adjusting for disease severity measured by a COPD Severity Score.

Results: Of 427 subjects, 44 (10.3%) reported using tiotropium in 2006. Adjusting for COPD severity, lower SES was associated with reduced odds of tiotropium use (OR 0.3; 95% CI 0.1-0.7; p = 0.005). Among the subset with lung function data (n = 95), after including COPD Global Obstructive Lung Disease (GOLD) Stage > or = 2 in the model, lower SES remained associated with reduced odds oftiotropium use (OR 0.03; 95% CI < 0.001-0.7; p = 0.03). Including forced expiratory volume in one second in the model as a continuous variable instead of GOLD Stage > or = 2 yielded similar results for lower SES (OR 0.1; 95% CI < 0.001-0.5; p = 0.02).

Conclusion: There was a strong SES gradient in tiotropium use such that there was less use with lower SES. To the extent that this is an efficacious medication for COPD, this gradient represents a potential source of health disparities.

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Related in: MedlinePlus

Recruitment and retention of study subjects.
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f1-copd-3-483: Recruitment and retention of study subjects.

Mentions: We used cross-sectional data from the 2006 interview Wave 5 only of a population-based, multi-wave longitudinal cohort study of US adults with airways disease that includes a subset of persons with COPD. The details of subject recruitment and retention over five waves of interview history from 2001 through 2006 are summarized in Figure 1. Analyses based on earlier interview waves have been reported previously (Trupin et al 2003; Blanc et al 2004; Chen et al 2006). The 427 interviews used in this analysis included 136 persons with COPD retained through four previous interview waves and 291 persons with COPD newly recruited.


Socioeconomic gradients in tiotropium use among adults with COPD.

Blanc PD, Eisner MD, Yelin EH, Earnest G, Balmes JR, Gregorich SE, Katz PP - Int J Chron Obstruct Pulmon Dis (2008)

Recruitment and retention of study subjects.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2629974&req=5

f1-copd-3-483: Recruitment and retention of study subjects.
Mentions: We used cross-sectional data from the 2006 interview Wave 5 only of a population-based, multi-wave longitudinal cohort study of US adults with airways disease that includes a subset of persons with COPD. The details of subject recruitment and retention over five waves of interview history from 2001 through 2006 are summarized in Figure 1. Analyses based on earlier interview waves have been reported previously (Trupin et al 2003; Blanc et al 2004; Chen et al 2006). The 427 interviews used in this analysis included 136 persons with COPD retained through four previous interview waves and 291 persons with COPD newly recruited.

Bottom Line: Among the subset with lung function data (n = 95), after including COPD Global Obstructive Lung Disease (GOLD) Stage > or = 2 in the model, lower SES remained associated with reduced odds oftiotropium use (OR 0.03; 95% CI < 0.001-0.7; p = 0.03).Including forced expiratory volume in one second in the model as a continuous variable instead of GOLD Stage > or = 2 yielded similar results for lower SES (OR 0.1; 95% CI < 0.001-0.5; p = 0.02).There was a strong SES gradient in tiotropium use such that there was less use with lower SES.

View Article: PubMed Central - PubMed

Affiliation: Division of Occupational and Environmental Medicine, Cardiovascular Research Institute, University of California San Francisco, San Francisco, CA 94143-0924, USA. paul.blanc@ucsf.edu

ABSTRACT

Background: Inequalities in the use of new medications may contribute to health disparities. We analyzed socioeconomic gradients in the use of tiotropium for chronic obstructive pulmonary disease (COPD).

Methods: In a cohort of adults with COPD aged > or = 55 years identified through population-based sampling, we elicited questionnaire responses on demographics, socioeconomic status (SES; lower SES defined as high school education or less or annual household income < US $20,000), and medication use and other clinical variables. In a subset we obtained pulmonary function testing. We used multiple logistic regression analysis to estimate the associations between SES and tiotropium use in COPD, adjusting for disease severity measured by a COPD Severity Score.

Results: Of 427 subjects, 44 (10.3%) reported using tiotropium in 2006. Adjusting for COPD severity, lower SES was associated with reduced odds of tiotropium use (OR 0.3; 95% CI 0.1-0.7; p = 0.005). Among the subset with lung function data (n = 95), after including COPD Global Obstructive Lung Disease (GOLD) Stage > or = 2 in the model, lower SES remained associated with reduced odds oftiotropium use (OR 0.03; 95% CI < 0.001-0.7; p = 0.03). Including forced expiratory volume in one second in the model as a continuous variable instead of GOLD Stage > or = 2 yielded similar results for lower SES (OR 0.1; 95% CI < 0.001-0.5; p = 0.02).

Conclusion: There was a strong SES gradient in tiotropium use such that there was less use with lower SES. To the extent that this is an efficacious medication for COPD, this gradient represents a potential source of health disparities.

Show MeSH
Related in: MedlinePlus