Løkke Anders, Hilberg Ole, Kjellberg Jakob, Ibsen Rikke, Jennum Poul
1Department of Respiratory Medicine, Aarhus County Hospital, Aarhus, Denmark.
COPD. 2014 Jun;11(3):237-46. doi: 10.3109/15412555.2013.839647. Epub 2013 Dec 19.
Chronic Obstructive Pulmonary Disease (COPD) is among the leading causes of morbidity and mortality worldwide, but longitudinal studies of the economic consequences of COPD are scarce. This study evaluated the economic consequences of COPD patients in Denmark and their spouses at a national level before and after initial diagnosis.
Using records from the Danish National Patient Registry (1998-2010), 171,557 patients with COPD and 86,260 spouses were identified; patients were compared with 664,821, and the spouses with 346,524, all controls were randomly selected and matched for age, gender and residence. Direct and indirect costs, including frequency of primary and secondary sector contacts and procedures, medication, unemployment benefits and social transfer payments were extracted from national databases for patients, spouses and controls.
COPD patients are earning approximately half of that of controls before diagnosis. After diagnosis this effect diminishes due to people getting older and retiring from work (65 years). Total health expenses are more than twice as high in the COPD group regardless of age and gender compared to controls. Spouses of COPD patients had significantly higher rates of health-related contacts, medication use and higher socioeconomic costs compared to controls. The employment and income rates of employed spouses of COPD patients were significantly lower compared to controls.
This study provides unique data on the economic consequences of COPD patients in Denmark and their spouses as well as displaying the serious health consequences for the individual spouse and society. Second, data shows substantial impact of COPD on income level and health expenses regardless of age and gender. It could be speculated that early identification and intervention might contribute to more health and economic equality between patients and controls.
慢性阻塞性肺疾病(COPD)是全球发病和死亡的主要原因之一,但关于COPD经济后果的纵向研究却很匮乏。本研究在国家层面评估了丹麦COPD患者及其配偶在初次诊断前后的经济后果。
利用丹麦国家患者登记处(1998 - 2010年)的记录,确定了171,557例COPD患者和86,260名配偶;将患者与664,821名对照进行比较,配偶与346,524名对照进行比较,所有对照均随机选取,并按年龄、性别和居住地进行匹配。从国家数据库中提取患者、配偶和对照的直接和间接成本,包括初级和二级部门接触及诊疗程序的频率、药物治疗、失业救济金和社会转移支付。
COPD患者在诊断前的收入约为对照的一半。诊断后,由于人们年龄增长并退休(65岁),这种影响会减弱。无论年龄和性别,COPD组的总医疗费用是对照组的两倍多。与对照组相比,COPD患者的配偶有更高的与健康相关的接触率、药物使用率和更高的社会经济成本。COPD患者在职配偶的就业和收入率显著低于对照组。
本研究提供了关于丹麦COPD患者及其配偶经济后果的独特数据,同时也显示了对个体配偶和社会的严重健康后果。其次,数据表明COPD对收入水平和医疗费用有重大影响,无论年龄和性别。可以推测,早期识别和干预可能有助于患者和对照之间实现更多的健康和经济平等。