Ajmera Mayank, Sambamoorthi Usha, Metzger Aaron, Dwibedi Nilanjana, Rust George, Tworek Cindy
RTI Health Solutions, Research Triangle Park, North Carolina.
Department of Pharmaceutical Systems and Policy.
Respir Care. 2015 Nov;60(11):1592-602. doi: 10.4187/respcare.03788. Epub 2015 Sep 1.
Multimorbidity is highly prevalent among patients with COPD. The association between multimorbidity and COPD medication management is not well researched. The aim of this study was to examine the association between multimorbidity and COPD medication receipt among Medicaid beneficiaries with newly diagnosed COPD.
A retrospective longitudinal dynamic cohort design was used, and data were extracted from Medicaid Analytic eXtract files from 2005 to 2008. Medicaid beneficiaries with newly diagnosed COPD (N = 19,060) were identified using the International Classification of Diseases, 9th Revision, Clinical Modification, for COPD. This code (for commonly co-occurring conditions with COPD) was used to create a multimorbidity variable. These conditions included anxiety, arthritis, bipolar disorder, cardiovascular diseases, depression, diabetes, hypertension, hyperlipidemia osteoporosis, and schizophrenia. Medicaid beneficiaries with newly diagnosed COPD were categorized as: (1) physical multimorbidity only, (2) psychiatric multimorbidity only, (3) both physical and psychiatric multimorbidity, and (4) no multimorbidity. Receipt of COPD medications (short- or long-acting bronchodilators, inhaled corticosteroids) was identified using National Drug Codes. Bivariate relationships between multimorbidity and COPD medication receipt were tested using the chi-square test of independence. The associations between multimorbidity and COPD medication receipt were analyzed with logistic and multinomial logistic regression analyses.
Among Medicaid beneficiaries with newly diagnosed COPD, 81.9% had at least one co-occurring chronic condition. After controlling for subject characteristics, adults with multimorbidity were less likely to receive COPD medications compared with those without any inflammation-related multimorbidity. For example, those with physical multimorbidity were less likely to receive short-acting bronchodilators (adjusted odds ratio [OR] 0.76, 95% CI 0.69-0.83), long-acting bronchodilators (adjusted OR 0.84, 95% CI 0.76-0.92), and inhaled corticosteroids (adjusted OR 0.75, 95% CI 0.68-0.82) compared with those with no inflammation-related multimorbidity.
The prevalence of multimorbidity is very high among Medicaid beneficiaries with newly diagnosed COPD. Our findings indicate poor COPD medication management among those with multimorbidity.
慢性阻塞性肺疾病（COPD）患者中多种疾病共存的情况非常普遍。多种疾病共存与COPD药物管理之间的关联尚未得到充分研究。本研究的目的是调查新诊断为COPD的医疗补助受益人中多种疾病共存与COPD药物使用之间的关联。
采用回顾性纵向动态队列设计，数据从2005年至2008年的医疗补助分析提取文件中提取。使用国际疾病分类第九版临床修订本确定新诊断为COPD的医疗补助受益人（N = 19,060）。该代码（用于与COPD常见共病情况）用于创建多种疾病共存变量。这些疾病包括焦虑症、关节炎、双相情感障碍、心血管疾病、抑郁症、糖尿病、高血压、高脂血症、骨质疏松症和精神分裂症。新诊断为COPD的医疗补助受益人分为：（1）仅存在躯体多种疾病共存，（2）仅存在精神多种疾病共存，（3）躯体和精神多种疾病共存，以及（4）无多种疾病共存。使用国家药品编码确定COPD药物（短效或长效支气管扩张剂、吸入性糖皮质激素）的使用情况。使用独立性卡方检验测试多种疾病共存与COPD药物使用之间的双变量关系。通过逻辑回归和多项逻辑回归分析分析多种疾病共存与COPD药物使用之间的关联。
在新诊断为COPD的医疗补助受益人中，81.9%至少有一种共病慢性病。在控制了受试者特征后，与没有任何炎症相关多种疾病共存的成年人相比，患有多种疾病共存的成年人接受COPD药物治疗的可能性较小。例如，与没有炎症相关多种疾病共存者相比，患有躯体多种疾病共存者接受短效支气管扩张剂治疗的可能性较小（调整后的优势比[OR]为0.76，95%置信区间为0.69 - 0.83），接受长效支气管扩张剂治疗的可能性较小（调整后的OR为0.84，95%置信区间为0.76 - 0.92），接受吸入性糖皮质激素治疗的可能性较小（调整后的OR为0.75，95%置信区间为0.68 - 0.82）。
新诊断为COPD的医疗补助受益人中多种疾病共存情况非常普遍。我们的研究结果表明，多种疾病共存者的COPD药物管理较差。
