Disease Burden and Health-Related Quality of Life (HRQoL) of Chronic Obstructive Pulmonary Disease (COPD) in the US – Evidence from the Medical Expenditure Panel Survey (MEPS) from 2016-2019

Abstract

Purpose

Chronic obstructive pulmonary disease (COPD) is a progressive disease associated with reduced life expectancy, increased morbidity, mortality, and cost. This study characterized the US COPD burden, including socioeconomic and health-related quality of life (HRQoL) outcomes.

Study Design and Methods

In this retrospective, cross-sectional study using nationally representative estimates from Medical Expenditures Survey (MEPS) data (2016–2019), adults (≥18 years) living with and without COPD were identified. Adults living without COPD (control cohort) and with COPD were matched 5:1 on age, sex, geographic region, and entry year. Demographics, clinical characteristics, socioeconomic, and generic HRQoL measures were examined to include a race-stratified analysis of people living with COPD.

Results

A total of 4,135 people living with COPD were identified; the matched dataset represented a weighted non-institutionalized population of 11.3 million with and 54.2 million people without COPD. Among people living with COPD, 66.3% had ≥1 COPD-related condition; 62.7% had ≥1 cardiovascular condition, compared to 33.5% and 50.5% without COPD. More people living with COPD were unemployed (56.2% vs 45.3%), unable to work due to illness/disability (30.1% vs 12.1%), had problems paying bills (16.1% vs 8.8%), reported poorer perceived health (fair/poor: 36.2% vs 14.4%), missed more working days due to illness/injury per year (median, 2.5 days vs 0.0 days), and had limitations in physical functioning (40.1% vs 19.4%) (all P<0.0001). In race-stratified analyses for people living with COPD, people self-reporting as Black had higher prevalence of cardiovascular-risk conditions, poorer socioeconomic and HRQoL outcomes, and higher healthcare expenses than White or Other races.

Conclusion

Adults living with COPD had higher clinical disease burden, lower socioeconomic status, and reduced HRQoL than those without, with greater disparities among Black people living with COPD compared to White and other races. Understanding the characteristics of patients helps address care disparities and access challenges.

Keywords:

• COPD
• burden of illness
• healthcare cost
• race/ethnicity

Abbreviations

AHRQ, Agency for Healthcare Research and Quality; ATS, American Thoracic Society; BRFSS, Behavioral Risk Factor Surveillance System; CFR, Code of Federal Regulations; CHD, coronary heart disease; CHF, congestive heart failure; COPD, chronic obstructive pulmonary disease; CVD, cardiovascular disease; CV, cardiovascular; ED, emergency department; FLOW, Function, Living, Outcomes, and Work; HCRU, healthcare resource utilization; HRQoL, health-related quality of life; ICD-10-CM, International Classification of Diseases, Tenth Revision, Clinical Modification; IRB, Institutional Review Board; MEPS, Medical Expenditure Panel Survey; OR, odds ratio; PRO, patient-reported outcome; SD, standard deviation.

Ethics Approval and Informed Consent

Given the robust deidentification and public-use policies of the data sources used in this study (ie, no use of restricted data files), investigators had no direct interaction with patients. The study conducted secondary analyses on data that were accessible to the public and not restricted to researchers. Therefore, no informed consent was required, and no subject and IRB approval was needed. Please note, MEPS is reviewed annually by an IRB and has IRB approval by Westat IRB. https://meps.ahrq.gov/communication/participants/faq_gen_mpc.shtml#FAQ10

Acknowledgments

This study was previously presented in poster form at the 2023 American Thoracic Society (ATS) Annual Meeting. The authors would like to acknowledge Ashwini Warke, PhD, RPh, formerly of Cencora, for her contributions as a medical writer to this manuscript.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or all these areas; took part in drafting, revising, or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

MFP and NF are full-time employees and stockholders of AstraZeneca. MHR, DMM, and DWM are paid consultants of AstraZeneca. MHR reports consulting and/or research funding from AstraZeneca, GSK plc., and Sunovion Pharmaceuticals. DMM is a paid consultant to AstraZeneca, GSK plc, Regeneron, Genentech, Up-to-Date, and Schlesinger Law Firm. He is also an expert witness on behalf of people suing the tobacco and vaping industries. DWM reports research funding from AstraZeneca, GSK plc., and Sunovion Pharmaceuticals and is a paid consultant for Novartis and Theravance. EF, OL, and SA are or were employees of Cencora at the time research was conducted. The authors report no other conflicts of interest in this work.

Additional information

Funding

AstraZeneca Pharmaceuticals LP provided funding for the research and the manuscript. The sponsor provided financial support for conducting the research. The sponsor provided oversight in the design of the study, the collection and analysis of the data, and the preparation of the manuscript.