Mortality in Western Australian seniors with chronic respiratory diseases: a cohort study

BMC Public Health

Research Article

David B Preen¹  C D'Arcy J Holman¹  Kristjana Einarsdóttir¹  Frank M Sanfilippo¹  Raylene Reeve²  Jon D Emery² 

[1] Centre for Health Services Research, School of Population Health, The University of Western Australia, 35 Stirling Highway, 6009, Crawley, Perth, Australia;School of Primary, Aboriginal and Rural Health Care, The University of Western Australia, 35 Stirling Highway, 6009, CrawleyPerth, Australia;

关键词: Chronic Obstructive Pulmonary Disease;    Chronic Obstructive Pulmonary Disease Patient;    Tiotropium;    Western Australia;    Nedocromil;   

DOI  :  10.1186/1471-2458-10-385

 received in 2009-07-08, accepted in 2010-07-01,  发布年份 2010

来源: Springer

【 摘 要 】

BackgroundRelatively few studies have examined survival by pharmacotherapy level and the effects of patient characteristics on mortality by pharmacotherapy level in older chronic respiratory disease (CRD) patients. This study aimed to investigate these issues in older (≥ 65) CRD patients in Western Australia.MethodsWe identified 108,312 patients ≥ 65 years with CRD during 1992-2006 using linked medical, pharmaceutical, hospital and mortality databases held by the Commonwealth and State governments. Pharmacotherapy classification levels were designed by a clinical consensus panel. Cox regression was used to investigate the study aim.ResultsPatients using only short acting bronchodilators experienced similar, but slightly worse survival than patients in the highest pharmacotherapy level group using high dose inhaled corticosteroids (ICS) ± long acting bronchodilators (LABs) ± oral steroids. Patients using low to medium dose ICS ± LABs experienced relatively better survival. Also, male gender was associated with all-cause mortality in all patients (HR = 1.72, 95% CI 1.65-1.80) and especially in those in the highest pharmacotherapy level group (HR = 1.97, 95%CI = 1.84-2.10). The P-value of interaction between gender and pharmacotherapy level for the effect on all-cause death was significant (0.0003).ConclusionsOlder patients with CRD not using ICS experienced the worst survival in this study and may benefit from an escalation in therapeutic regime. Males had a higher risk of death than females, which was more pronounced in the highest pharmacotherapy level group. Hence, primary health care should more actively direct disease management to mild-to-moderate disease patients.

【 授权许可】

CC BY   
© Einarsdóttir et al; licensee BioMed Central Ltd. 2010