Michael C. Steiner
Socioeconomic deprivation and the outcome of pulmonary rehabilitation in England and Wales
Steiner, Michael C.; Lowe, Derek; Beckford, Katy; Blakey, John; Bolton, Charlotte E.; Elkin, Sarah; Man, William D -C.; Roberts, C. Michael; Sewell, Louise; Walker, Paul; Singh, Sally J.
Authors
Derek Lowe
Katy Beckford
John Blakey
Professor CHARLOTTE BOLTON charlotte.bolton@nottingham.ac.uk
Professor of Respiratory Medicine
Sarah Elkin
William D -C. Man
C. Michael Roberts
Louise Sewell
Paul Walker
Sally J. Singh
Abstract
Background: Pulmonary rehabilitation (PR) improves exercise capacity and health status in patients with COPD, but many patients assessed for PR do not complete therapy. It is unknown whether socioeconomic deprivation associates with rates of completion of PR or the magnitude of clinical benefits bequeathed by PR.
Methods: PR services across England and Wales enrolled patients to the National PR audit in 2015. Deprivation was assessed using Index of Multiple Deprivation (IMD) derived from postcodes. Study outcomes were completion of therapy and change in measures of exercise performance and health status. Univariate and multivariate analyses investigated associations between IMD and these outcomes.
Results: 210 PR programmes enrolled 7413 patients. Compared with the general population, the PR sample lived in relatively deprived neighbourhoods. There was a statistically significant association between rates of completion of PR and quintile of deprivation (70% in the least and 50% in the most deprived quintiles). After baseline adjustments, the risk ratio (95% CI) for patients in the most deprived relative to the least deprived quintile was 0.79 (0.73 to 0.85), p<0.001. After baseline adjustments, IMD was not significantly associated with improvements in exercise performance and health status.
Conclusions: In a large national dataset, we have shown that patients living in more deprived areas are less likely to complete PR. However, deprivation was not associated with clinical outcomes in patients who complete therapy. Interventions targeted at enhancing referral, uptake and completion of PR among patients living in deprived areas could reduce morbidity and healthcare costs in such hard-to-reach populations.
Citation
Steiner, M. C., Lowe, D., Beckford, K., Blakey, J., Bolton, C. E., Elkin, S., Man, W. D. .-C., Roberts, C. M., Sewell, L., Walker, P., & Singh, S. J. (2017). Socioeconomic deprivation and the outcome of pulmonary rehabilitation in England and Wales. Thorax, 72(6), 530-537. https://doi.org/10.1136/thoraxjnl-2016-209376
Journal Article Type | Article |
---|---|
Acceptance Date | Dec 1, 2016 |
Online Publication Date | Jan 11, 2017 |
Publication Date | Jun 1, 2017 |
Deposit Date | Jan 25, 2017 |
Publicly Available Date | Jan 25, 2017 |
Journal | Thorax |
Print ISSN | 0040-6376 |
Electronic ISSN | 1468-3296 |
Publisher | BMJ Publishing Group |
Peer Reviewed | Peer Reviewed |
Volume | 72 |
Issue | 6 |
Pages | 530-537 |
DOI | https://doi.org/10.1136/thoraxjnl-2016-209376 |
Keywords | COPD epidemiology, Pulmonary rehabilitation |
Public URL | https://nottingham-repository.worktribe.com/output/863437 |
Publisher URL | http://thorax.bmj.com/content/72/6/530 |
Contract Date | Jan 25, 2017 |
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Copyright Statement
Copyright information regarding this work can be found at the following address: http://creativecommons.org/licenses/by-nc/4.0
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