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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.

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Authors

Michael C. Steiner

Derek Lowe

Katy Beckford

John Blakey

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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