title: Socioeconomic Status, Sex, Age and Access to Medications for COPD in Ontario, Canada.
abstract: Disparities in COPD health outcomes have been found with older individuals, men and those of lower socioeconomic status doing worse. We sought to determine if this was due to differences in access to COPD medications. We conducted a retrospective cohort study using population health administrative data from Ontario, Canada, a province with universal prescription drug coverage for older adults. All individuals with COPD aged 67 years and older in 2008 who were not taking inhaled long-acting bronchodilators or inhaled corticosteroids were followed for 2 years. Poisson regression was used to determine the effects of age, sex, and socioeconomic status on the likelihood of initiating one of these medications, after adjusting for potential confounders. Over the study period, 54,050 of 185,698 (29.1%) older individuals with COPD not previously taking any inhaled long-acting bronchodilators or corticosteroids were initiated on one or more of these medications. After adjustment, individuals of low socioeconomic status, measured using neighborhood income level quintiles, were slightly more likely to initiate COPD medications than those of high socioeconomic status (relative risk (RR) 1.05; 95% confidence interval (95% CI) 1.02-1.08). While men received COPD medication at a consistent rate across all age groups, the likelihood that a woman received medication decreased with increasing age. With the exception of older women, there was minimal disparity in prescription for COPD medications. Disparity in health outcomes among Ontario COPD patients is not clearly explained by differences in medication access by socioeconomic status, sex or age.
authors.affiliation: a Institute for Clinical Evaluative Sciences , Toronto , Ontario , Canada.|b Sunnybrook Health Sciences Centre , Toronto , Ontario , Canada.|c The Hospital for Sick Children , Toronto , Ontario , Canada.|d University of Toronto , Toronto , Ontario , Canada.
authors.forename: Andrea
authors.initials: A
authors.lastname: Gershon
authors.affiliation: a Institute for Clinical Evaluative Sciences , Toronto , Ontario , Canada.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Campitelli
authors.affiliation: a Institute for Clinical Evaluative Sciences , Toronto , Ontario , Canada.
authors.forename: Jeremiah
authors.initials: J
authors.lastname: Hwee
authors.affiliation: a Institute for Clinical Evaluative Sciences , Toronto , Ontario , Canada.
authors.forename: Ruth
authors.initials: R
authors.lastname: Croxford
authors.affiliation: a Institute for Clinical Evaluative Sciences , Toronto , Ontario , Canada.|c The Hospital for Sick Children , Toronto , Ontario , Canada.|d University of Toronto , Toronto , Ontario , Canada.
authors.forename: Teresa
authors.initials: T
authors.lastname: To
authors.affiliation: a Institute for Clinical Evaluative Sciences , Toronto , Ontario , Canada.|d University of Toronto , Toronto , Ontario , Canada.
authors.forename: Matthew B
authors.initials: MB
authors.lastname: Stanbrook
authors.affiliation: a Institute for Clinical Evaluative Sciences , Toronto , Ontario , Canada.|b Sunnybrook Health Sciences Centre , Toronto , Ontario , Canada.|d University of Toronto , Toronto , Ontario , Canada.
authors.forename: Ross
authors.initials: R
authors.lastname: Upshur
authors.affiliation: a Institute for Clinical Evaluative Sciences , Toronto , Ontario , Canada.
authors.forename: Anne
authors.initials: A
authors.lastname: Stephenson
authors.affiliation: a Institute for Clinical Evaluative Sciences , Toronto , Ontario , Canada.
authors.forename: Thérèse A
authors.initials: TA
authors.lastname: Stukel
mesh_terms: D000318:Adrenergic beta-Agonists / Q000627:therapeutic use; D000328:Adult; D000367:Age Factors; D000368:Aged; D001993:Bronchodilator Agents / Q000627:therapeutic use; D018680:Cholinergic Antagonists / Q000627:therapeutic use; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006297:Health Services Accessibility; D054625:Healthcare Disparities; D006801:Humans; D008297:Male; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy* / Q000453:epidemiology; D012189:Retrospective Studies; D012737:Sex Factors; D012959:Socioeconomic Factors
chemical_list: D000318:Adrenergic beta-Agonists; D001993:Bronchodilator Agents; D018680:Cholinergic Antagonists; D005938:Glucocorticoids
keywords: community health; drug coverage; health inequity; population health