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Socioeconomic Status as a Determinant of Health Status Treatment Response in COPD Trials.

Jones, PW; Gelhorn, H; Wilson, H; Benson, VS; Karlsson, N; Menjoge, S; Müllerova, H; Rennard, SI; Tal-Singer, R; Merrill, D; et al. Jones, PW; Gelhorn, H; Wilson, H; Benson, VS; Karlsson, N; Menjoge, S; Müllerova, H; Rennard, SI; Tal-Singer, R; Merrill, D; Tabberer, M (2017) Socioeconomic Status as a Determinant of Health Status Treatment Response in COPD Trials. Chronic Obstr Pulm Dis, 4 (2). pp. 150-158. ISSN 2372-952X https://doi.org/10.15326/jcopdf.4.2.2017.0132
SGUL Authors: Jones, Paul Wyatt

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Abstract

Background: Randomized controlled trials (RCTs) often recruit patients from low and high socioeconomic status (SES) countries, but little is known about the effect of SES on clinical outcomes, particularly patient-centered measures of symptomatic benefit. Methods: Combined individual chronic obstructive pulmonary disease (COPD) patient data from the placebo and long-acting bronchodilator arms of 17 RCTs (from the COPD Biomarkers Qualification Consortium database) were analyzed. Health status was measured using the St George's Respiratory Questionnaire (SGRQ) (minimum clinically important difference [MCID]: 4 units). Trials were grouped into short-term (≤12 months) and medium-term (>12 months to 48 months). A participant's country of residence was categorized into Low/Medium or High SES using World Health Organization criteria. Results: Data from 19765 individuals (6109 Low/Medium SES) were available. Patients in Low/Medium SES countries had more severe disease at baseline. Improvement in SGRQ score with placebo was ≈2 units greater in Low/Medium than in High SES countries; at its greatest, the improvement from baseline exceeded the MCID in Low/Medium countries. This difference was maintained for at least 1 year. Improvement with bronchodilator was also greater in Low/Medium versus High SES countries; overall there was no evidence that the treatment effect versus placebo was different between countries of different SES status. Conclusions: Participants in Low/Medium SES countries experienced significantly larger treatment effects, irrespective of treatment group (placebo and bronchodilator). Despite this, COPD patients in Low/Medium SES countries experienced a health status gain from long-acting bronchodilator treatment that is similar to that seen in High SES countries.

Item Type: Article
Additional Information: Provided here with permission from the COPDF Foundation. Originally published at http://doi.org/10.15326/jcopdf.4.2.2017.0132
Keywords: SGRQ, St George’s Respiratory Questionnaire, chronic obstructive pulmonary disease, copd, health status, socioeconomic status
SGUL Research Institute / Research Centre: Academic Structure > Infection and Immunity Research Institute (INII)
Journal or Publication Title: Chronic Obstr Pulm Dis
ISSN: 2372-952X
Language: eng
Dates:
DateEvent
1 April 2017Published
1 February 2017Accepted
Publisher License: Publisher's own licence
PubMed ID: 28848924
Go to PubMed abstract
URI: http://openaccess.sgul.ac.uk/id/eprint/109132
Publisher's version: https://doi.org/10.15326/jcopdf.4.2.2017.0132

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