Influence of deprivation on health care use, health care costs, and mortality in COPD

Peter F Collins,^1–3 Rebecca J Stratton,¹ Ramesh J Kurukulaaratchy,^4,5 Marinos Elia<sup>1

1</sup>NIHR Nutrition Biomedical Research Centre, Faculty of Medicine, University of Southampton, Southampton General Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, Hampshire, UK; ²Nutrition and Dietetics, School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia; ³Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, QLD, Australia; ⁴NIHR Respiratory Biomedical Research Centre, Southampton General Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, Hampshire, UK; ⁵Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, Hampshire, UK

Background and aim: Deprivation is associated with the incidence of COPD, but its independent impact on clinical outcomes is still relatively unknown. This study aimed to explore the influence of deprivation on health care use, costs, and survival.
Methods: A total of 424 outpatients with COPD were assessed for deprivation across two hospitals. The English Index of Multiple Deprivation (IMD) was used to establish a deprivation score for each patient. The relationship between deprivation and 1-year health care use, costs, and mortality was examined, controlling for potential confounding variables (age, malnutrition risk, COPD severity, and smoking status).
Results: IMD was significantly and independently associated with emergency hospitalization (β-coefficient 0.022, SE 0.007; p=0.001), length of hospital stay, secondary health care costs (β-coefficient £101, SE £30; p=0.001), and mortality (HR 1.042, 95% CI 1.015–1.070; p=0.002). IMD was inversely related to participation in exercise rehabilitation (OR 0.961, 95% CI 0.930–0.994; p=0.002) and secondary care appointments. Deprivation was also significantly related to modifiable risk factors (smoking status and malnutrition risk).
Conclusion: Deprivation in patients with COPD is associated with increased emergency health care use, health care costs, and mortality. Tackling deprivation is complex; however, strategies targeting high-risk groups and modifiable risk factors, such as malnutrition and smoking, could reduce the clinical and economic burden.

Keywords: COPD, economics, socioeconomic, deprivation