Abstract
BackgroundRelatively few studies have examined survival by pharmacotherapy level and the effects of patient characteristics on mortality by pharmacotherapy level in older chronic respiratory disease (CRD) patients. This study aimed to investigate these issues in older (≥ 65) CRD patients in Western Australia.MethodsWe identified 108,312 patients ≥ 65 years with CRD during 1992-2006 using linked medical, pharmaceutical, hospital and mortality databases held by the Commonwealth and State governments. Pharmacotherapy classification levels were designed by a clinical consensus panel. Cox regression was used to investigate the study aim.ResultsPatients using only short acting bronchodilators experienced similar, but slightly worse survival than patients in the highest pharmacotherapy level group using high dose inhaled corticosteroids (ICS) ± long acting bronchodilators (LABs) ± oral steroids. Patients using low to medium dose ICS ± LABs experienced relatively better survival. Also, male gender was associated with all-cause mortality in all patients (HR = 1.72, 95% CI 1.65-1.80) and especially in those in the highest pharmacotherapy level group (HR = 1.97, 95%CI = 1.84-2.10). The P-value of interaction between gender and pharmacotherapy level for the effect on all-cause death was significant (0.0003).ConclusionsOlder patients with CRD not using ICS experienced the worst survival in this study and may benefit from an escalation in therapeutic regime. Males had a higher risk of death than females, which was more pronounced in the highest pharmacotherapy level group. Hence, primary health care should more actively direct disease management to mild-to-moderate disease patients.
Highlights
Few studies have examined survival by pharmacotherapy level and the effects of patient characteristics on mortality by pharmacotherapy level in older chronic respiratory disease (CRD) patients
Patient Characteristics Of the 108,312 CRD patients in our study, 72% were selected on the basis of having had one or more CRD medication prescription, 3% were selected on the basis of a CRD hospital admission, 0.03% of having attended 'asthma cycle of care' general practitioner (GP) services and 25% on the basis of having records from various combinations of the four datasets
We studied the effect of patient characteristics on allcause mortality in older patients with CRD, overall and by pharmacotherapy level
Summary
Few studies have examined survival by pharmacotherapy level and the effects of patient characteristics on mortality by pharmacotherapy level in older chronic respiratory disease (CRD) patients. Asthma and Chronic Obstructive Pulmonary Disease (COPD) account for 80% of the total burden of chronic respiratory diseases (CRD) in Australia [1] and represent a significant burden to the Australian health care system [2,3] They are under-diagnosed among the older population because of atypical presentation and comorbidity [2,4,5]. The risk factors for mortality in older COPD patients have mainly been explored in patients who have been hospitalised for COPD [13,14] This is perhaps surprising given relatively high prevalence of asthma and COPD, an ageing population demographic and substantial health care costs resulting from primary and secondary care of patients with these conditions [8,15,16]. The effects of patient characteristics on mortality and how these effects differ according to pharmacotherapy level remains uncertain
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