title: Geographic differences in use of home oxygen for obstructive lung disease: a national Medicare study.
abstract: BACKGROUND
  Home oxygen is the most expensive equipment item that Medicare purchases ($1.7 billion/year).
  
  
  OBJECTIVE
  To assess geographic differences in supplemental oxygen use.
  
  
  METHODS
  Retrospective cohort analysis of oxygen claims for a 20% random sample of Medicare patients hospitalized for obstructive lung disease in 1999 and alive at the end of 2000.
  
  
  RESULTS
  While 33.7% of the 34,916 hospitalized patients used supplemental oxygen, there was more than a 4-fold difference between states and a greater than 6-fold difference between hospital referral regions with high/low utilization. Rocky Mountain States and Alaska had the highest utilization, while the District of Columbia and Louisiana had the lowest utilization. After adjusting for patient characteristics and elevation, high-utilization communities included low-lying areas in California, Florida, Michigan, Missouri, and Washington. Patients who were younger, male, white, and who had more comorbidities, more hospital admissions, and lived at higher altitudes and in areas of greater income also had higher odds of using supplemental oxygen. Residing in rural areas was associated with higher unadjusted oxygen use rates. After adjustment, patients living in large rural areas had higher odds of using oxygen than patients living in urban areas or in small rural areas.
  
  
  CONCLUSIONS
  There is significant geographic variation in supplemental oxygen use, even after controlling for patient and contextual factors. The Centers for Medicare & Medicaid Services should examine these issues further and enact changes that ensure patient health and fiscal responsibility.
authors.affiliation: Clinical Center, National Institutes of Health, Bethesda, Maryland 20892-1604, USA. chanle@cc.nih.gov
authors.forename: Leighton
authors.initials: L
authors.lastname: Chan
authors.forename: Nicholas
authors.initials: N
authors.lastname: Giardino
authors.forename: Gordon
authors.initials: G
authors.lastname: Rubenfeld
authors.forename: Laura-Mae
authors.initials: LM
authors.lastname: Baldwin
authors.forename: Meredith A
authors.initials: MA
authors.lastname: Fordyce
authors.forename: L Gary
authors.initials: LG
authors.lastname: Hart
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D005843:Geography; D006699:Home Care Services; D006801:Humans; D008173:Lung Diseases, Obstructive / Q000628:therapy*; D008297:Male; D006278:Medicare; D010102:Oxygen Inhalation Therapy / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014481:United States
references.citation: J Fam Pract. 2001 Aug;50(8):676-80
references.pmid: 11509161
references.citation: J Rural Health. 2004 Spring;20(2):99-108
references.pmid: 15085622
references.citation: J Clin Epidemiol. 1992 Jun;45(6):613-9
references.pmid: 1607900
references.citation: J Rural Health. 2000 Winter;16(1):31-42
references.pmid: 10916313
references.citation: J Rural Health. 2000 Fall;16(4):337-48
references.pmid: 11218320
references.citation: Health Care Manage Rev. 2001 Summer;26(3):40-9
references.pmid: 11482174
references.citation: Aust J Rural Health. 2003 Apr;11(2):64-72
references.pmid: 12780496
references.citation: Chest. 2001 Jun;119(6):1711-6
references.pmid: 11399695
references.citation: Respir Care. 2000 Feb;45(2):223-8; discussion 228-30
references.pmid: 10771794
references.citation: Am J Prev Med. 2001 Oct;21(3):182-8
references.pmid: 11567838
references.citation: N Engl J Med. 2007 Feb 1;356(5):447-58
references.pmid: 17267905
references.citation: Cochrane Database Syst Rev. 2000;(4):CD001744
references.pmid: 11034726
references.citation: JAMA. 1994 Mar 16;271(11):845-50
references.pmid: 8114239
references.citation: Chest. 2002 Nov;122(5):1661-7
references.pmid: 12426268