PROJECTING DISPARITIES IN THE CLINICAL AND ECONOMIC BURDEN OF COPD BY NEIGHBOURHOOD-LEVEL SOCIOECONOMIC DEPRIVATION IN THE UNITED STATES
Author(s)
Kevin Yan, PhD(c), BScPharm, RPh1, Panagis Galiatsatos, MD, MHS2, Mohsen Sadatsafavi, PhD, MD1, Chris Carlsten, MD, MPH1, Kate Johnson, MSc, PhD1, Kevin Duan, MD, MSc1.
1University of British Columbia, Vancouver, BC, Canada, 2Johns Hopkins University School of Medicine, Baltimore, MD, USA.
1University of British Columbia, Vancouver, BC, Canada, 2Johns Hopkins University School of Medicine, Baltimore, MD, USA.
OBJECTIVES: Health outcomes in patients with Chronic Obstructive Pulmonary Disease (COPD) are heterogeneous but tend to be worse in socioeconomically deprived neighborhoods. However, area-based socioeconomic factors are rarely considered in simulation models of COPD. We incorporated Area Deprivation Index (ADI), a ranking of neighbourhoods in the U.S. based on education, employment, housing, and income, into a discrete event simulation model of COPD and projected disparities in the burden of COPD.
METHODS: We used Evaluation Platform of COPD in the US (EPIC-US), a validated model of COPD in the general U.S population aged ≥40, to project neighborhood-level disparities in healthcare costs, quality-adjusted life years (QALYs), and exacerbations from 2025-2060. We assigned simulated agents an ADI quintile (Q1=least to Q5=most deprived) using the 2023 Neighborhood Atlas and U.S. population-weighted probability. We used prevalence ratios of COPD by ADI quintile (Q1:reference, Q2:1.0, Q3:1.2, Q4:1.6, Q5:2.4), and an incidence rate ratio of 1.56 total COPD exacerbations in Q5 vs Q1. The prevalence of COPD and exacerbation rate for the general population was preserved. We evaluated national excess exacerbations, medical costs and QALYs lost cumulatively and per-person measures in Q5-Q2 compared to Q1 over a 35-year horizon.
RESULTS: Between 2025-2060, there were 47.5 million (95% CI: 43.8-51.1) excess exacerbations in Q5, 30.9 million (27.6-34.1) in Q4, 18.3 million (15.4-21.2) in Q3, and 9.3 million (6.6-12.0) in Q2 relative to Q1. Cumulative excess costs were $115.5 billion ($91.4-135.7) in Q5, $73.5 billion ($53.4-93.5) in Q4, $47.2 billion ($28.8-$65.6) in Q3, and $22.7 billion ($5.7-$39.7) in Q2. Excess QALYs lost were 638,597 (511,530-765,664) in Q5, 389,174 (274,782-503,566) in Q4, 228,824 (123,717-333,932) in Q3, and 128,764 (30,244-277,284) in Q2.
CONCLUSIONS: COPD burden is concentrated in disadvantaged communities; and these disparities are widening over time. Policymakers should prioritize targeted interventions and reallocate resources to mitigate disparities between groups.
METHODS: We used Evaluation Platform of COPD in the US (EPIC-US), a validated model of COPD in the general U.S population aged ≥40, to project neighborhood-level disparities in healthcare costs, quality-adjusted life years (QALYs), and exacerbations from 2025-2060. We assigned simulated agents an ADI quintile (Q1=least to Q5=most deprived) using the 2023 Neighborhood Atlas and U.S. population-weighted probability. We used prevalence ratios of COPD by ADI quintile (Q1:reference, Q2:1.0, Q3:1.2, Q4:1.6, Q5:2.4), and an incidence rate ratio of 1.56 total COPD exacerbations in Q5 vs Q1. The prevalence of COPD and exacerbation rate for the general population was preserved. We evaluated national excess exacerbations, medical costs and QALYs lost cumulatively and per-person measures in Q5-Q2 compared to Q1 over a 35-year horizon.
RESULTS: Between 2025-2060, there were 47.5 million (95% CI: 43.8-51.1) excess exacerbations in Q5, 30.9 million (27.6-34.1) in Q4, 18.3 million (15.4-21.2) in Q3, and 9.3 million (6.6-12.0) in Q2 relative to Q1. Cumulative excess costs were $115.5 billion ($91.4-135.7) in Q5, $73.5 billion ($53.4-93.5) in Q4, $47.2 billion ($28.8-$65.6) in Q3, and $22.7 billion ($5.7-$39.7) in Q2. Excess QALYs lost were 638,597 (511,530-765,664) in Q5, 389,174 (274,782-503,566) in Q4, 228,824 (123,717-333,932) in Q3, and 128,764 (30,244-277,284) in Q2.
CONCLUSIONS: COPD burden is concentrated in disadvantaged communities; and these disparities are widening over time. Policymakers should prioritize targeted interventions and reallocate resources to mitigate disparities between groups.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
HPR78
Topic
Epidemiology & Public Health, Health Policy & Regulatory, Methodological & Statistical Research
Topic Subcategory
Health Disparities & Equity
Disease
Respiratory-Related Disorders (Allergy, Asthma, Smoking, Other Respiratory)