RT Journal Article
SR Electronic
T1 Socioeconomic deprivation and the outcome of pulmonary rehabilitation in England and Wales
JF Thorax
JO Thorax
FD BMJ Publishing Group Ltd and British Thoracic Society
SP 530
OP 537
DO 10.1136/thoraxjnl-2016-209376
VO 72
IS 6
A1 Michael C Steiner
A1 Derek Lowe
A1 Katy Beckford
A1 John Blakey
A1 Charlotte E Bolton
A1 Sarah Elkin
A1 William D -C Man
A1 C Michael Roberts
A1 Louise Sewell
A1 Paul Walker
A1 Sally J Singh
YR 2017
UL http://thorax.bmj.com/content/72/6/530.abstract
AB Background Pulmonary rehabilitation (PR) improves exercise capacity and health status in patients with COPD, but many patients assessed for PR do not complete therapy. It is unknown whether socioeconomic deprivation associates with rates of completion of PR or the magnitude of clinical benefits bequeathed by PR.Methods PR services across England and Wales enrolled patients to the National PR audit in 2015. Deprivation was assessed using Index of Multiple Deprivation (IMD) derived from postcodes. Study outcomes were completion of therapy and change in measures of exercise performance and health status. Univariate and multivariate analyses investigated associations between IMD and these outcomes.Results 210 PR programmes enrolled 7413 patients. Compared with the general population, the PR sample lived in relatively deprived neighbourhoods. There was a statistically significant association between rates of completion of PR and quintile of deprivation (70% in the least and 50% in the most deprived quintiles). After baseline adjustments, the risk ratio (95% CI) for patients in the most deprived relative to the least deprived quintile was 0.79 (0.73 to 0.85), p<0.001. After baseline adjustments, IMD was not significantly associated with improvements in exercise performance and health status.Conclusions In a large national dataset, we have shown that patients living in more deprived areas are less likely to complete PR. However, deprivation was not associated with clinical outcomes in patients who complete therapy. Interventions targeted at enhancing referral, uptake and completion of PR among patients living in deprived areas could reduce morbidity and healthcare costs in such hard-to-reach populations.