COPD IN THE UNITED STATES: FACTORS AFFECTING TREATMENT PATTERNS AND UTILIZATION OF PHARMACOTHERAPY
Author(s)
Khang Nguyen, PharmD, MS1, Richard H. STANFORD, MS, PharmD2, Carrie Blanchard, PharmD, MPH2, Joshua M. Thorpe, PhD, MPH1;
1UNC Chapel Hill Eshelman School of Pharmacy, Chapel Hill, NC, USA, 2AESARA, Chapel Hill, NC, USA
1UNC Chapel Hill Eshelman School of Pharmacy, Chapel Hill, NC, USA, 2AESARA, Chapel Hill, NC, USA
OBJECTIVES: Despite strong evidence supporting guideline-recommended pharmacotherapy for chronic obstructive pulmonary disease (COPD), access to and utilization of these treatments may vary across patient populations. This study aimed to assess disparities in COPD pharmacotherapy use across sociodemographic, socioeconomic, and health system factors.
METHODS: From 2012-2022, a nationally representative cohort of adults aged ≥50 years with COPD was identified using the Medical Expenditure Panel Survey (MEPS). COPD was defined using ICD-9-CM codes (491, 492, 494, 496) in 2012-2014 and ICD-10-CM codes (J40-J44) in 2016-2022. Pharmacotherapy use was classified into defining categories, including no COPD medication, rescue-only therapy, inhaled corticosteroids only, long-acting bronchodilator monotherapy, and combination long-term maintenance therapy. Guideline-recommended therapy was assessed for each study year to reflect evolving treatment recommendations. Guided by the Andersen Behavioral Model of Health Services Use, multinomial logistic regression models assessed associations between optimal pharmacotherapy category and predisposing, enabling, and medical need factors. All analyses were performed using Stata 19.
RESULTS: Overall, 58.2% of adults with COPD received no or rescue-only treatment, 5.9% received inhaled corticosteroids only, and 35.9% received long-term maintenance therapy. After statistical adjustment, race/ethnicity, education, and having a usual source of care were associated with optimal medication use. Hispanic (OR=0.64; 95% CI: 0.48-0.85) and non-Hispanic Black adults (OR=0.81; 95% CI: 0.72-0.91) had lower odds of being prescribed optimal maintenance pharmacotherapy. Additionally, a lower level of education was associated with reduced odds of maintenance therapy use (OR=0.84; 95% CI: 0.74-0.96), while having a usual source of care was linked to increased odds of receiving appropriate pharmacotherapy (OR=2.04; 95% CI: 1.28-3.23).
CONCLUSIONS: The majority of US adults with COPD are receiving suboptimal care, which was influenced by predisposing and enabling factors of race/ethnicity, education, and source of care. These finding suggest opportunity to address specific barriers to increasing long-term maintenance pharmacotherapy use in these populations.
METHODS: From 2012-2022, a nationally representative cohort of adults aged ≥50 years with COPD was identified using the Medical Expenditure Panel Survey (MEPS). COPD was defined using ICD-9-CM codes (491, 492, 494, 496) in 2012-2014 and ICD-10-CM codes (J40-J44) in 2016-2022. Pharmacotherapy use was classified into defining categories, including no COPD medication, rescue-only therapy, inhaled corticosteroids only, long-acting bronchodilator monotherapy, and combination long-term maintenance therapy. Guideline-recommended therapy was assessed for each study year to reflect evolving treatment recommendations. Guided by the Andersen Behavioral Model of Health Services Use, multinomial logistic regression models assessed associations between optimal pharmacotherapy category and predisposing, enabling, and medical need factors. All analyses were performed using Stata 19.
RESULTS: Overall, 58.2% of adults with COPD received no or rescue-only treatment, 5.9% received inhaled corticosteroids only, and 35.9% received long-term maintenance therapy. After statistical adjustment, race/ethnicity, education, and having a usual source of care were associated with optimal medication use. Hispanic (OR=0.64; 95% CI: 0.48-0.85) and non-Hispanic Black adults (OR=0.81; 95% CI: 0.72-0.91) had lower odds of being prescribed optimal maintenance pharmacotherapy. Additionally, a lower level of education was associated with reduced odds of maintenance therapy use (OR=0.84; 95% CI: 0.74-0.96), while having a usual source of care was linked to increased odds of receiving appropriate pharmacotherapy (OR=2.04; 95% CI: 1.28-3.23).
CONCLUSIONS: The majority of US adults with COPD are receiving suboptimal care, which was influenced by predisposing and enabling factors of race/ethnicity, education, and source of care. These finding suggest opportunity to address specific barriers to increasing long-term maintenance pharmacotherapy use in these populations.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
HSD95
Topic
Health Service Delivery & Process of Care
Disease
SDC: Respiratory-Related Disorders (Allergy, Asthma, Smoking, Other Respiratory)