Abstract
Introduction: Little is known about “real-life” use of evidence-based recommended drugs in COPD. We tested the hypothesis that drug prescription vary according to socioeconomic position.
Methods: All people (35-64 years old) discharged in 2006-07 with a diagnosis of COPD exacerbation, resident in Rome (2.700.000 inhabitants) were selected from Hospital Information System (standardized ICD-9-CM coding). Drugs were retrieved from the regional drug prescription registry based on ATC codes (12-months follow-up after discharge). An area-based (census block) socioeconomic position (SEP) index was used for each patient (quintiles: I well off, V disadvantaged). Logistic regression was performed to take into account gender, age and comorbidities.
Results: 779 individuals were studied (mean age 58.1, 58% men). 55% were in the lower SEP levels. Disadvantaged people were more likely to have respiratory failure, diabetes, ischemic heart disease and heart failure. Proportions of people with at least two prescriptions during 12 months after discharge were: long-acting inhalants 70%, short-term inhalants 45%, xanthines 23%. No statistically difference was observed across SEP groups for long-acting (OR= 1.20, 95% IC=0.67-2.16) or short-acting inhalants (OR=1.55, 95% IC= 0.90-2.68), while xanthines were more frequently prescribed for low SEP people (SEP-V vs. SEP-I OR=2.17, 95% IC=1.03-4.57; p trend <0.05).
Conclusions: Disadvantaged COPD patients seem more exposed to xanthines whose effectiveness is less clear in comparison to inhalant drugs. We highlight the need for improving outpatient care programmes to reduce disparity in health.
- © 2011 ERS