PRS4 - Multimorbidity and Copd Medication Receipt Among Medicaid Beneficiaries With Newly-Diagnosed Copd

Abstract

Multimorbidity is highly prevalent among individuals with Chronic Obstructive Pulmonary Disease (COPD). The association between multimorbidity and COPD medication management is not well researched. This study sought to examine the association between multimorbidity and receipt of COPD medications among Medicaid beneficiaries with newly diagnosed COPD. Retrospective longitudinal dynamic cohort design was used and data were extracted from multiple years (2005-2008) of Medicaid Analytic eXtract (MAX) files. Medicaid beneficiaries with newly diagnosed COPD (N = 19,060) were identified using International Classification of Diseases Codes (ICD-9-CM) codes for COPD. ICD-9-CM codes for commonly co-occurring conditions with COPD were used to create multimorbidity variable. These conditions included arthritis, cardiovascular diseases (CVD), depression, diabetes, hypertension, hyperlipidemia and osteoporosis. Medicaid beneficiaries with newly diagnosed COPD were categorized into following multimorbidity categories: 1) physical multimorbidity only; 2) mental multimorbidity only; 3) both physical and mental multimorbidity and 4) no multimorbidity. Receipt of COPD medications (short-acting, long-acting bronchodilators and inhaled corticosteroids) was identified using National Drug Codes. Bivariate relationships between multimorbidity and COPD medication receipt were tested using chi-square test of independence. The associations between multimorbidity and COPD medication receipt were analyzed with logistic and multinomial logistic regressions. Among Medicaid beneficiaries with newly diagnosed COPD, 74.9% had at least one co-occurring chronic condition. After controlling for patient characteristics, adults with multimorbidity were less likely to receive COPD medications compared to those without any multimorbidity. For example those with physical multimorbidity were less likely to receive short-acting bronchodilators (AOR: 0.82; 95% CI: 0.75, 0.89), long-acting bronchodilators (AOR: 0.86; 95% CI: 0.79, 0.93) and inhaled corticosteroids (AOR: 0.81; 95% CI: 0.75, 0.88) compared to those with no inflammation-related multimorbidity. Prevalence of multimorbidity is very high among Medicaid beneficiaries with newly diagnosed COPD. Our study findings suggest poor COPD medication management among those with multimorbidity.