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Geographical and sociodemographic differences in discontinuation of medication for chronic obstructive pulmonary disease – a cross-classified multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA)

Khalaf, Kani LU ; Fisk, Sten Axelsson LU ; Ekberg-Jansson, Ann ; Leckie, George LU ; Perez-Vicente, Raquel LU and Merlo, Juan LU (2020) In Clinical Epidemiology 12. p.783-796
Abstract

Background: While discontinuation of COPD maintenance medication is a known problem, the proportion of patients with discontinuation and its geographical and sociodemographic distribution are so far unknown in Sweden. Therefore, we analyse this question by applying an innovative approach called multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA). Patients and Methods: We analysed 49,019 patients categorized into 18 sociodemographic contexts and 21 counties of residence. All patients had a hospital COPD diagnosis and had been on inhaled maintenance medication during the 5 years before the study baseline in 2010. We defined “discontinuation” as the absolute lack of retrieval from a pharmacy of any inhaled... (More)

Background: While discontinuation of COPD maintenance medication is a known problem, the proportion of patients with discontinuation and its geographical and sociodemographic distribution are so far unknown in Sweden. Therefore, we analyse this question by applying an innovative approach called multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA). Patients and Methods: We analysed 49,019 patients categorized into 18 sociodemographic contexts and 21 counties of residence. All patients had a hospital COPD diagnosis and had been on inhaled maintenance medication during the 5 years before the study baseline in 2010. We defined “discontinuation” as the absolute lack of retrieval from a pharmacy of any inhaled maintenance medication during 2011. We performed a cross-classified MAIHDA and obtained the average proportion of discontinuation, as well as county and sociodemographic absolute risks, and compared them with a proposed benchmark value of 10%. We calculated the variance partition coefficient (VPC) and the area under the receiver operating characteristics curve (AUC) to quantify county and sociodemographic differences. To summarize the results, we used a framework with 15 scenarios defined by the size of the differences and the level of achievement in relation to the benchmark value. Results: Around 18% of COPD patients in Sweden discontinued maintenance medication, so the benchmark value was not achieved. There were very small county differences (VPC=0.35%, AUC=0.54). The sociodemographic differences were small (VPC=4.98%, AUC=0.57). Conclusion: Continuity of maintenance medication among COPD patients in Sweden could be improved by reducing the unjustifiably high prevalence of discontinuation. The very small county and small sociodemographic differences should motivate universal interventions across all counties and sociodemographic groups. Geographical analyses should be combined with sociodemographic analyses, and the cross-classified MAIHDA is an appropriate tool to assess health-care quality.

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author
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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Compliance, COPD, Discriminatory accuracy, Equity in health care, Health care quality, Multilevel analysis, Socioeconomic inequity
in
Clinical Epidemiology
volume
12
pages
14 pages
publisher
Dove Press
external identifiers
  • scopus:85088570472
ISSN
1179-1349
DOI
10.2147/CLEP.S247368
language
English
LU publication?
yes
id
6f902ca2-72dd-495c-a6a2-0a40d1794ee4
date added to LUP
2020-08-05 10:53:08
date last changed
2020-08-12 09:09:34
@article{6f902ca2-72dd-495c-a6a2-0a40d1794ee4,
  abstract     = {<p>Background: While discontinuation of COPD maintenance medication is a known problem, the proportion of patients with discontinuation and its geographical and sociodemographic distribution are so far unknown in Sweden. Therefore, we analyse this question by applying an innovative approach called multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA). Patients and Methods: We analysed 49,019 patients categorized into 18 sociodemographic contexts and 21 counties of residence. All patients had a hospital COPD diagnosis and had been on inhaled maintenance medication during the 5 years before the study baseline in 2010. We defined “discontinuation” as the absolute lack of retrieval from a pharmacy of any inhaled maintenance medication during 2011. We performed a cross-classified MAIHDA and obtained the average proportion of discontinuation, as well as county and sociodemographic absolute risks, and compared them with a proposed benchmark value of 10%. We calculated the variance partition coefficient (VPC) and the area under the receiver operating characteristics curve (AUC) to quantify county and sociodemographic differences. To summarize the results, we used a framework with 15 scenarios defined by the size of the differences and the level of achievement in relation to the benchmark value. Results: Around 18% of COPD patients in Sweden discontinued maintenance medication, so the benchmark value was not achieved. There were very small county differences (VPC=0.35%, AUC=0.54). The sociodemographic differences were small (VPC=4.98%, AUC=0.57). Conclusion: Continuity of maintenance medication among COPD patients in Sweden could be improved by reducing the unjustifiably high prevalence of discontinuation. The very small county and small sociodemographic differences should motivate universal interventions across all counties and sociodemographic groups. Geographical analyses should be combined with sociodemographic analyses, and the cross-classified MAIHDA is an appropriate tool to assess health-care quality.</p>},
  author       = {Khalaf, Kani and Fisk, Sten Axelsson and Ekberg-Jansson, Ann and Leckie, George and Perez-Vicente, Raquel and Merlo, Juan},
  issn         = {1179-1349},
  language     = {eng},
  pages        = {783--796},
  publisher    = {Dove Press},
  series       = {Clinical Epidemiology},
  title        = {Geographical and sociodemographic differences in discontinuation of medication for chronic obstructive pulmonary disease – a cross-classified multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA)},
  url          = {http://dx.doi.org/10.2147/CLEP.S247368},
  doi          = {10.2147/CLEP.S247368},
  volume       = {12},
  year         = {2020},
}