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Mortality and Disease Progression in WA Seniors with Obstructive Airways Disease. A whole-population linked data study (XJSC 403928). Dr Kristjana Einarsdottir , Dr David B Preen, Prof Jon Emery, Prof D’Arcy Holman Centre for Health Services Research, UWA School of Population Health.

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mortality and disease progression in wa seniors with obstructive airways disease

Mortality and Disease Progression in WA Seniors with Obstructive Airways Disease

A whole-population linked data study (XJSC 403928)

Dr Kristjana Einarsdottir, Dr David B Preen, Prof Jon Emery, Prof D’Arcy Holman

Centre for Health Services Research, UWA School of Population Health

background
Background
  • Asthma prevalence 10-12% in Australian adults
  • COPD prevalence 9-12% in Australian adults >45
  • Similar manifestations in older people despite different causes
    • > Obstructive Airways Disease
  • Limited work done on risk factors for all-cause mortality in older asthma/COPD patients
    • Particularly by severity level
slide3
Aims
  • Describe the effect of
    • gender, ethnicity, socio-economic status, and residential remoteness
    • GP visit regularity
  • on disease progression and mortality by disease severity among older asthma/COPD patients in WA
data sources
Data Sources
  • WA used linked data for WA Seniors ≥65 years between 1st Jan 1992 - 31st Dec 2006
    • HMDS
    • Death Registry
    • Electoral Roll
    • MBS
    • PBS
  • Linkages created by Cross-Jurisdictional Linkage Facility of the WA Data Linkage System (WADLS) maintained by the WA Department of Health
identification of study population
Identification of Study Population
  • HMDS
    • Individuals with asthma or COPD diagnoses
  • Death Registry
    • Individuals who had died from asthma or COPD
  • MBS
    • Individuals who had used ‘asthma cycle of care’ services
  • PBS
    • Individuals who had been prescribed asthma or COPD medication
study population
Study Population
  • 108,455 obstructive airway disease patients (asthma or COPD)
  • Disease severity level classification
    • Medication use
    • Hospital admissions
  • Statistics
    • Cox Proportional Hazards Model
results disease severity survival
Results – Disease Severity Survival

* Adjusted for gender, ethnicity, age, socio-economic status, residential remoteness, Charlson Index, admission type and length of hospital stay

results mortality
Results – Mortality

Characteristics of patients with obstructive airways disease and risk of death, overall and by disease severity

* Adjusted forgender, ethnicity, age, socio-economic status, residential remoteness, Charlson Index, admission type and length of hospital stay

results disease progression
Results – Disease Progression

Characteristics of patients with obstructive airways disease and risk of progression to a higher level of disease severity

* Adjusted for gender, ethnicity, age, socio-economic status, residential remoteness, Charlson Index, admission type and length of hospital stay

results gp visit regularity mortality
Results – GP Visit Regularity - Mortality

Association between GP visit regularity of patients with obstructive airway disease and risk of death

* Adjusted for number of GP visits, gender, ethnicity, age, socio-economic status, residential remoteness, Charlson Index, admission type and length of hospital stay

results gp visit regularity disease progression
Results – GP Visit Regularity - Disease Progression

GP visit regularity of patients with obstructive airway disease and risk of disease progression

* Adjusted for number of GP visits, gender, ethnicity, age, socio-economic status, residential remoteness, Charlson Index, admission type and length of hospital stay

conclusions
Conclusions
  • Mild disease group had 2nd worst survival after severe group
  • Effect of male gender and low SES on mortality was pronounced in patients with severe disease
  • Effect of indigenous status and low SES on disease progression was stronger if disease was already moderately severe
  • Visiting a GP regularly was protective against all-cause mortality and disease progression (if disease already moderate)
acknowledgements
Acknowledgements
  • Dr David Preen
  • Prof Jon Emery
  • Prof D’Arcy Holman
  • Dr Frank Sanfilippo
  • Department of Health WA, Data Linkage team
  • Commonwealth Department of Health and Ageing
  • Medicare Australia