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BMC Public Health
Published in: BMC Public Health 1/2010

Open Access 01-12-2010 | Research article

Mortality in Western Australian seniors with chronic respiratory diseases: a cohort study

Authors: Kristjana Einarsdóttir, David B Preen, Frank M Sanfilippo, Raylene Reeve, Jon D Emery, C D'Arcy J Holman

Published in: BMC Public Health | Issue 1/2010

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Abstract

Background

Relatively 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.

Methods

We 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.

Results

Patients 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).

Conclusions

Older 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.
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Literature
1.
Begg S, Vos T, Barker B, Stevenson C, Stanley L, Lopez A: The burden of disease and injury in Australia 2003. 2007, Australian Institute of Health and Ageing. AIHW cat. no. PHE 82. Canberra
2.
Frith PA, Cafarella PA, Duffy JM: Chronic obstructive pulmonary disease (COPD) is a major personal and public health burden in Australia. Aust N Z J Public Health. 2008, 32 (2): 139-141. 10.1111/j.1753-6405.2008.00190.x.CrossRefPubMed
3.
Asthma in Australia 2008. 2008, Australian centre for asthma monitoring and Australian Institute of Health and Welfare. AIHW cat. no. ACM 14. Canberra
4.
Matheson MC, Abeysena C, Raven JM, Skoric B, Johns DP, Abramson MJ, Walters EH: How have we been managing chronic obstructive pulmonary disease in Australia?. Intern Med J. 2006, 36 (2): 92-99. 10.1111/j.1445-5994.2006.01011.x.CrossRefPubMed
5.
Braman SS, Hanania NA: Asthma in older adults. Clin Chest Med. 2007, 28 (4): 685-702. 10.1016/j.ccm.2007.08.007. vCrossRefPubMed
6.
Jenkins CR, Thompson PJ, Gibson PG, Wood-Baker R: Distinguishing asthma and chronic obstructive pulmonary disease: why, why not and how?. Med J Aust. 2005, 183 (1 Suppl): S35-37.PubMed
7.
Asthma and chronic obstructive pulmonary disease among older people in Australia: deaths and hospitalisations. 2006, Australian Centre for Asthma Monitoring and Australian Institute of Health and Welfare. AIHW cat. no. ACM 7. Canberra
8.
Abramson M, Matheson M, Wharton C, Sim M, Walters EH: Prevalence of respiratory symptoms related to chronic obstructive pulmonary disease and asthma among middle aged and older adults. Respirology. 2002, 7 (4): 325-331. 10.1046/j.1440-1843.2002.00408.x.CrossRefPubMed
9.
Asthma Management Handbook 2006. 2006, National Asthma Council Australia. Melbourne
10.
Australia's health 2008. 2008, Australian Institute of Health and Welfare. Cat. no. AUS 99 Canberra
11.
Dantzer C, Tessier JF, Nejjari C, Barberger-Gateau P, Dartigues JF: Mortality of elderly subjects with self-reported asthma in a French cohort,1991-1996. Eur J Epidemiol. 2001, 17 (1): 57-63. 10.1023/A:1010996718008.CrossRefPubMed
12.
Bellia V, Pedone C, Catalano F, Zito A, Davi E, Palange S, Forastiere F, Incalzi RA: Asthma in the elderly: mortality rate and associated risk factors for mortality. Chest. 2007, 132 (4): 1175-1182. 10.1378/chest.06-2824.CrossRefPubMed
13.
Nie JX, Wang L, Upshur RE: Mortality of elderly patients in Ontario after hospital admission for chronic obstructive pulmonary disease. Can Respir J. 2007, 14 (8): 485-489.CrossRefPubMedPubMedCentral
14.
Fruchter O, Yigla M: Predictors of long-term survival in elderly patients hospitalized for acute exacerbations of chronic obstructive pulmonary disease. Respirology. 2008, 13 (6): 851-855. 10.1111/j.1440-1843.2008.01367.x.CrossRefPubMed
15.
Wilson DH, Tucker G, Frith P, Appleton S, Ruffin RE, Adams RJ: Trends in hospital admissions and mortality from asthma and chronic obstructive pulmonary disease in Australia, 1993-2003. Med J Aust. 2007, 186 (8): 408-411.PubMed
16.
Geelhoed EA, Brameld KJ, Holman CD, Thompson PJ: Readmission and survival following hospitalization for chronic obstructive pulmonary disease: long-term trends. Intern Med J. 2007, 37 (2): 87-94. 10.1111/j.1445-5994.2007.01240.x.CrossRefPubMed
17.
Phua GC, Macintyre NR: Inhaled corticosteroids in obstructive airway disease. Respir Care. 2007, 52 (7): 852-858.PubMed
18.
Miller-Larsson A, Selroos O: Advances in asthma and COPD treatment: combination therapy with inhaled corticosteroids and long-acting beta 2-agonists. Curr Pharm Des. 2006, 12 (25): 3261-3279. 10.2174/138161206778194187.CrossRefPubMed
19.
Calverley PM, Anderson JA, Celli B, Ferguson GT, Jenkins C, Jones PW, Yates JC, Vestbo J: Salmeterol and fluticasone propionate and survival in chronic obstructive pulmonary disease. N Engl J Med. 2007, 356 (8): 775-789. 10.1056/NEJMoa063070.CrossRefPubMed
20.
Holman CD, Bass AJ, Rouse IL, Hobbs MS: Population-based linkage of health records in Western Australia: development of a health services research linked database. Aust N Z J Public Health. 1999, 23 (5): 453-459. 10.1111/j.1467-842X.1999.tb01297.x.CrossRefPubMed
21.
Harris MG, Harris RD: The Australian health system: continuity and change. J Health Hum Serv Adm. 1998, 20 (4): 442-467.PubMed
22.
Census of Population and Housing: Socio-Economic Indexes for Areas, Australia. 2001, Australian Bureau of Statistics. Cat no. 2039.0. Canberra
23.
Outcomes of ABS Views on Remoteness Consultation, Australia. 2001, Australian Bureau of Statistics. Cat no. 1244.0.00.001. Canberra
24.
Charlson ME, Pompei P, Ales KL, MacKenzie CR: A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987, 40 (5): 373-383. 10.1016/0021-9681(87)90171-8.CrossRefPubMed
25.
Household Expenditure on Health: A Snapshot, 2004-05. 2008, Australian Bureau of Statistics cat no. 4836.0.55.001. Canberra
26.
Patterns of asthma medication use in Australia. 2007, Australian Centre for Asthma Monitoring and Australian Institute of health and welfare. AIHW cat. no. ACM 11. Canberra
27.
Vollmer WM, Peters D, Crane B, Kelleher C, Buist AS: Impact of regular inhaled corticosteroid use on chronic obstructive pulmonary disease outcomes. COPD. 2007, 4 (2): 135-142. 10.1080/15412550701341186.CrossRefPubMed
28.
Sin DD, Tu JV: Underuse of inhaled steroid therapy in elderly patients with asthma. Chest. 2001, 119 (3): 720-725. 10.1378/chest.119.3.720.CrossRefPubMed
29.
Sin DD, Tu JV: Inhaled corticosteroids and the risk of mortality and readmission in elderly patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2001, 164 (4): 580-584.CrossRefPubMed
30.
Sin DD, Tu JV: Inhaled corticosteroid therapy reduces the risk of rehospitalization and all-cause mortality in elderly asthmatics. Eur Respir J. 2001, 17 (3): 380-385. 10.1183/09031936.01.17303800.CrossRefPubMed
31.
Krigsman K, Moen J, Nilsson JL, Ring L: Refill adherence by the elderly for asthma/chronic obstructive pulmonary disease drugs dispensed over a 10-year period. J Clin Pharm Ther. 2007, 32 (6): 603-611. 10.1111/j.1365-2710.2007.00866.x.CrossRefPubMed
32.
Enright PL, McClelland RL, Newman AB, Gottlieb DJ, Lebowitz MD: Underdiagnosis and undertreatment of asthma in the elderly. Cardiovascular Health Study Research Group. Chest. 1999, 116 (3): 603-613. 10.1378/chest.116.3.603.CrossRefPubMed
33.
Keene J, Li X: Age and gender differences in health service utilization. J Public Health (Oxf). 2005, 27 (1): 74-79. 10.1093/pubmed/fdh208.CrossRef
34.
Singh AK, Cydulka RK, Stahmer SA, Woodruff PG, Camargo CA: Sex differences among adults presenting to the emergency department with acute asthma. Multicenter Asthma Research Collaboration Investigators. Archives of Internal Medicine. 1999, 159 (11): 1237-1243. 10.1001/archinte.159.11.1237.CrossRefPubMed
35.
Baibergenova A, Thabane L, Akhtar-Danesh N, Levine M, Gafni A, Leeb K: Sex differences in hospital admissions from emergency departments in asthmatic adults: A population-based study. Annals of Allergy, Asthma and Immunology. 2006, 96 (5): 666-672. 10.1016/S1081-1206(10)61063-0.CrossRefPubMed
36.
Trawick DR, Holm C, Wirth J: Influence of gender on rates of hospitalization hospital course, and hypercapnea in high-risk patients admitted for asthma: a 10-year retrospective study at Yale-New Haven Hospital. Chest. 2001, 119 (1): 115-119. 10.1378/chest.119.1.115.CrossRefPubMed
37.
Skobeloff EM, Spivey WH, St Clair SS, Schoffstall JM: The influence of age and sex on asthma admissions. JAMA. 1992, 268 (24): 3437-3440. 10.1001/jama.268.24.3437.CrossRefPubMed
38.
Prescott E, Lange P, Vestbo J: Effect of gender on hospital admissions for asthma and prevalence of self-reported asthma: a prospective study based on a sample of the general population. Copenhagen City Heart Study Group. Thorax. 1997, 52 (3): 287-289. 10.1136/thx.52.3.287.CrossRefPubMedPubMedCentral
39.
Osborne ML, Vollmer WM, Linton KL, Buist AS: Characteristics of patients with asthma within a large HMO: a comparison by age and gender. Am J Respir Crit Care Med. 1998, 157 (1): 123-128.CrossRefPubMed
40.
Tsai CL, Clark S, Cydulka RK, Rowe BH, Camargo CA: Factors associated with hospital admission among emergency department patients with chronic obstructive pulmonary disease exacerbation. Acad Emerg Med. 2007, 14 (1): 6-14. 10.1111/j.1553-2712.2007.tb00360.x.CrossRefPubMed
41.
Rao S, Raju P, Smina M, Upadya A, Amoateng-Adjepong Y, Manthous CA: Gender and status asthmaticus. J Asthma. 2003, 40 (7): 763-767. 10.1081/JAS-120023503.CrossRefPubMed
42.
Experimental Estimates of Aboriginal and Torres Strait Islander Australians, Jun 2006. 2006, Australian Bureau of Statistics. cat. no. 3238.0.55.001. Canberra
43.
The health and welfare of Australia's Aboriginal and Torres Strait Islander peoples. 2008, Australian Bureau of Statistics and Australian Institute of Health and Welfare. AIHW cat. no. IHW 21, ABS cat. no. 4704.0. Canberra
44.
Cranston JM, Crockett AJ, Moss JR, Pegram RW, Stocks NP: Models of chronic disease management in primary care for patients with mild-to-moderate asthma or COPD: a narrative review. Med J Aust. 2008, 188 (8 Suppl): S50-52.PubMed
Metadata
Title
Mortality in Western Australian seniors with chronic respiratory diseases: a cohort study
Authors
Kristjana Einarsdóttir
David B Preen
Frank M Sanfilippo
Raylene Reeve
Jon D Emery
C D'Arcy J Holman
Publication date
01-12-2010
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2010
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/1471-2458-10-385

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