title: Socioeconomic deprivation and the outcome of pulmonary rehabilitation in England and Wales.
abstract: 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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: Leicester Respiratory Biomedical Research Unit, Institute for Lung Health, University Hospitals of Leicester NHS Trust, Leicester, UK.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Steiner
authors.affiliation: Clinical Effectiveness and Evaluation Unit, Royal College of Physicians of London, London, UK.
authors.forename: Derek
authors.initials: D
authors.lastname: Lowe
authors.affiliation: Berkshire Healthcare NHS Foundation Trust, Bracknell, UK.
authors.forename: Katy
authors.initials: K
authors.lastname: Beckford
authors.affiliation: Liverpool School of Tropical Medicine and Aintree University Hospital, Liverpool, UK.
authors.forename: John
authors.initials: J
authors.lastname: Blakey
authors.affiliation: Nottingham Respiratory Research Unit, School of Medicine, University of Nottingham, Nottingham, UK.
authors.forename: Charlotte E
authors.initials: CE
authors.lastname: Bolton
authors.affiliation: Imperial College NHS Trust and NHLI, Imperial College, London, UK.
authors.forename: Sarah
authors.initials: S
authors.lastname: Elkin
authors.affiliation: NIHR Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust and Imperial College, Harefield, UK.|Harefield Pulmonary Rehabilitation Unit, Harefield Hospital, Harefield, UK.
authors.forename: William D-C
authors.initials: WD
authors.lastname: Man
authors.affiliation: Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
authors.forename: C Michael
authors.initials: CM
authors.lastname: Roberts
authors.affiliation: School of Health, CWG17, Coventry University, Coventry, UK.
authors.forename: Louise
authors.initials: L
authors.lastname: Sewell
authors.affiliation: Aintree University Hospital, Liverpool, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Walker
authors.affiliation: Leicester Respiratory Biomedical Research Unit, Institute for Lung Health, University Hospitals of Leicester NHS Trust, Leicester, UK.
authors.forename: Sally J
authors.initials: SJ
authors.lastname: Singh
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D004739:England / Q000453:epidemiology; D005080:Exercise Test / Q000379:methods; D017079:Exercise Tolerance; D005260:Female; D005541:Forced Expiratory Volume / Q000502:physiology; D006304:Health Status; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D011204:Poverty Areas; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology / Q000503:physiopathology / Q000534:rehabilitation*; D012959:Socioeconomic Factors; D016896:Treatment Outcome; D014852:Wales / Q000453:epidemiology
keywords: COPD epidemiology; Pulmonary Rehabilitation