Background
Methods
Data
Study population
Health care utilization and calculation of costs
Covariates and comorbidities
Comorbidity | ICD-10 codes |
---|---|
Diabetes | E10.0, E10.1, E10.2, E10.3, E10.4, E10.5, E10.6, E10.7, E10.8, E10.9, E11.0, E11.1, E11.2, E11.3, E11.4, E11.5, E11.6, E11.7, E11.8, E11.9, E12.0, E12.1, E12.2, E12.3, E12.4, E12.5, E12.6, E12.7, E12.8, E12.9, E13.0, E13.1, E13.2, E13.3, E13.4, E13.5, E13.6, E13.7, E13.8, E13.9, E14.0, E14.1, E14.2, E14.3, E14.4, E14.5, E14.6, E14.7, E14.8, E14.9 |
Stroke | G45, G46, I60, I61, I62, I63, I64, I65, I66, I67, I68, I69, H34.0 |
Myocardial infarction | I21, I22, I25.2 |
Cancer | C00, C01, C02, C04, C04, C05, C06, C07, C08, C09, C10, C11, C12, C13, C14, C15, C16, C17, C18, C19, C20, C21, C22, C23, C24, C25, C26, C30, C31, C32, C33, C34, C37, C37, C39, C40, C41, C43, C45, C46, C47, C48, C49, C50, C51, C52, C53, C54, C55, C56, C57, C58, C60, C61, C62, C63, C64, C65, C66, C67, C68, C69, C70, C71, C72, C73, C74, C75, C76, C81, C82, C83, C84, C85, C88, C90, C91, C92, C93, C94, C95, C96, C97 |
Arthritis | M05, M06, M31.5, M32, M33, M35.1, M35.3, M36.0 |
Statistical analysis
Results
Study population
GOLD grade 1 | GOLD grade 2 | GOLD grade 3 | GOLD grade 4 | p-value | |
---|---|---|---|---|---|
N
| 12,053 (30.7%) | 18,119 (46.1%) | 7383 (18.8%) | 1752 (4.5%) | |
Age (years) | 70.0 (11.7) | 70.1 (10.8) | 70.0 (9.8) | 67.8 (9.2) | < 0.0001 |
Age > 74 years | 4900 (40.7%) | 6980 (38.5%) | 2587 (35.0%) | 438 (25.0%) | < 0.0001 |
Age 65–74 years | 3448 (28.6%) | 5666 (31.3%) | 2636 (35.7%) | 682 (38.9%) | |
Age 55–64 years | 2443 (20.3%) | 4016 (22.2%) | 1733 (23.5%) | 506 (28.9%) | |
Age < 55 | 1262 (10.5%) | 1457 (8.0%) | 427 (5.8%) | 126 (7.2%) | |
Female | 6319 (52.4%) | 8268 (45.6%) | 2701 (36.6%) | 577 (32.9%) | < 0.0001 |
income < €5.000 | 2915 (24.2%) | 4222 (23.3%) | 1600 (21.7%) | 382 (21.8%) | < 0.0001 |
income€5000 < €10,000 | 3920 (32.5%) | 6140 (33.9%) | 2740 (37.1%) | 713 (40.7%) | |
income €10,000 < €15,000 | 2486 (20.6%) | 3868 (21.4%) | 1595 (21.6%) | 333 (19.0%) | |
income €15,000 < €20,000 | 944 (7.8%) | 1416 (7.8%) | 544 (7.4%) | 113 (6.5%) | |
income €20,000 < €30,000 | 1020 (8.5%) | 1383 (7.6%) | 497 (6.7%) | 112 (6.4%) | |
income €30,000 < €50,000 | 669 (5.6%) | 936 (5.2%) | 360 (4.9%) | 76 (4.3%) | |
income ≥ €50.000 | 99 (0.8%) | 154 (0.9%) | 47 (0.6%) | 23 (1.3%) | |
Current smokers | 3143 (26.1%) | 5822 (32.1%) | 2631 (35.6%) | 600 (34.3%) | < 0.0001 |
Former smokers (quit within the last 8 years) | 1343 (11.1%) | 2451 (13.5%) | 1327 (18.0%) | 402 (23.0%) | |
Never smokers or former smokers (quit > 8 years ago) | 7567 (62.8%) | 9846 (54.3%) | 3425 (46.4%) | 750 (42.8%) | |
BMI (kg/m2) | 29.3 (5.8) | 29.3 (6.2) | 27.9 (6.2) | 26.1 (6.1) | < 0.0001 |
Normal weight (18.5 ≤ BMI < 25) | 2578 (21.4%) | 4254 (23.5%) | 2243 (30.4%) | 681 (38.9%) | < 0.0001 |
Overweight (25 ≤ BMI < 30) | 4523 (37.5%) | 6370 (35.2%) | 2449 (33.2%) | 517 (29.5%) | |
Obese (BMI ≥ 30) | 4834 (40.1%) | 7247 (40.0%) | 2397 (32.5%) | 408 (23.3%) | |
Underweight (BMI < 18.5) | 118 (1.0%) | 248 (14.4%) | 294 (4.00%) | 146 (8.3%) | |
Diabetes | 4306 (35.7%) | 6669 (36.8%) | 2574 (34.9%) | 481 (27.5%) | < 0.0001 |
Stroke | 3509 (29.1%) | 5444 (30.1%) | 2055 (27.8%) | 406 (23.2%) | < 0.0001 |
Myocardial infarction | 1430 (11.9%) | 2371 (13.1%) | 1069 (14.5%) | 244 (13.9%) | < 0.0001 |
Cancer | 3612 (30.00%) | 5708 (31.5%) | 2318 (31.4%) | 470 (26.8%) | < 0.0001 |
Arthritis | 1853 (15.4%) | 2462 (13.6%) | 824 (11.2%) | 145 (8.3%) | < 0.0001 |
Health care utilization, work absence and retirement
GOLD grade 1 | GOLD grade 2 | GOLD grade 3 | GOLD grade 4 | p-value | |
N
| 12,053 (30.7%) | 18,119 (46.1%) | 7383 (18.8%) | 1752 (4.5%) | |
Healthcare utilization | |||||
Outpatient services | |||||
% User | 100.0 | 100.0 | 100.0 | 100.0 | 1.0000 |
Total number of visits | 15.8 (8.7) | 16.0 (9.0) | 15.3 (8.7) | 14.1 (8.0) | < 0.0001 |
General practitioner | 8.2 (5.7) | 8.4 (5.9) | 8.2 (5.8) | 7.8 (5.5) | < 0.0001 |
Specialist | 6.3 (5.4) | 6.4 (5.6) | 6.0 (5.3) | 5.3 (4.6) | < 0..0001 |
Inpatient services | |||||
% User | 10.9 | 12.7 | 17.5 | 23.0 | < 0.0001 |
Number of hospital days | 4.3 (12.5) | 4.8 (12.6) | 6.6 (14.6) | 8.9 (17.2) | < 0.0001 |
Prescribed medication | |||||
%User | 97.6 | 98.3 | 98.8 | 99.1 | < 0.0001 |
Number of prescribed drugs | 15.4 (12.1) | 17.0 (12.6) | 20.0 (14.5) | 22.1 (14.8) | < 0.0001 |
Direct costs | |||||
Outpatient costs | €548 | €600 | €604 | €564 | 0.0109 |
Inpatients costs | €2034 | €2271 | €3042 | €4192 | < 0.0001 |
Medication costs | €593 | €716 | €932 | €1478 | < 0.0001 |
Rehabilitation | €130 | €146 | €176 | €232 | < 0.0001 |
Aids and Remedies | €404 | €428 | €603 | €1016 | < 0.0001 |
Travel costs | €112 | €131 | €203 | €320 | < 0.0001 |
Total direct costs | €3821 | €4292 | €5561 | €7801 | < 0.0001 |
GOLD grade 1 | GOLD grade 2 | GOLD grade 3 | GOLD grade 4 | p-value | |
N
| 3705 (31.0%) | 5473 (45.7%) | 2160 (18.1%) | 632 (5.3%) | |
Works absenteeism (participants < 65 years) | |||||
%retired | 22.0 | 25.6 | 37.2 | 50.6 | < 0.0001 |
%employed | 52.9 | 47.0 | 38.3 | 25.6 | < 0.0001 |
% with sick days | 78.8 | 80.0 | 81.2 | 81.5 | 0.4724 |
Number of sick days | 43.3 | 44.9 | 53.0 | 66.1 | 0.0001 |
Indirect costs (participants < 65 years) | |||||
Sick days | €3069 | €3148 | €3138 | €2737 | < 0.0001 |
Premature retirement | €8777 | €10,188 | €14,743 | €20,195 | < 0.0001 |
Total indirect costs | €11,846 | €13,336 | €17,880 | €22,932 | < 0.0001 |
Costs
Covariate | Direct costs | Indirect cots | |||
---|---|---|---|---|---|
Basic model | Extended model | Basic model | Extended model | ||
Exp(beta) (CI 95%) | Exp(beta) (CI 95%) | Exp(beta) (CI 95%) | Exp(beta) (CI 95%) | ||
Intercept | 2349.13 (2236.80-2467.10) | 2047.55 (1937.01-2164.19) |
4225.11 (3770.26-4734.82)
| 3425.83 (2959.28-3965.95) | |
GOLD | Grade 1 | 1.00 | 1.00 |
1.00
| 1.00 |
Grade 2 |
1.13 (1.10–1.16)
|
1.12 (1.09–1.15)
|
1.08 (0.99–1.18)
|
1.08 (0.99–1.18)
| |
Grade 3 |
1.46 (1.41–1.51)
|
1.45 (1.40–1.50)
|
1.33 (1.19–1.49)
|
1.36 (1.21–1.52)
| |
Grade 4 |
2.18 (2.06–2.32)
|
2.29 (2.16–2.43)
|
1.64 (1.37–1.96)
|
1.74 (1.45–2.09)
| |
Age (years) | < 55 | 1.00 | 1.00 | 1.00 | 1.00 |
55–64 |
1.34 (1.28–1.40)
|
1.17 (1.12–1.23)
|
1.96 (1.80–2.14)
|
1.85 (1.70–2.02)
| |
65–74 |
1.57 (1.50–1.64)
|
1.26 (1.20–1.32)
| – | – | |
> 74 |
1.81 (1.73–1.89)
|
1.39 (1.32–1.46)
| – | – | |
Sex | Female | 1.00 | 1.00 | 1.00 | 1.00 |
Male |
1.04 (1.02–1.07)
| 1.00 (0.97–1.02) | 1.03 (0.95–1.12) | 1.03 (0.95–1.12) | |
Income | % income < €5.000 | 1.00 | 1.00 | 1.00 | 1.00 |
% income€5000 < €10,000 |
1.07 (1.04–1.10)
|
1.05 (1.02–1.08)
|
3.20 (2.85–3.59)
|
3.18 (2.83–3.57)
| |
% income €10,000 < €15,000 |
1.06 (1.02–1.10)
|
1.04 (1.01–1.08)
|
2.14 (1.87–2.46)
|
2.14 (1.87–2.45)
| |
% income €15,000 < €20,000 | 0.97 (0.93–1.02) | 0.99 (0.94–1.03) |
1.46 (1.26–1.68)
|
1.49 (1.29–1.38)
| |
% income €20,000 < €30,000 |
0.81 (0.77–0.87)
|
0.85 (0.81–0.89)
|
1.17 (1.03–1.31)
|
1.23 (1.09–1.38)
| |
% income €30,000 < €50,000 |
0.82 (0.77–0.87)
|
0.87 (0.82–0.92)
| 1.00 (0.89–1.14) | 1.05 (0.93–1.19) | |
% income ≥ €50.000 |
0.84 (0.74–0.96)
| 0.88 (0.78–1.00) | 1.01 (0.78–1.32) | 1.04 (0.80–1.35) | |
Smoking status | Never smokers or former smokers (quit > 8 years ago) |
1.00
| 1.00 | ||
Current smokers |
0.91 (0.89–0.94)
| 0.94 (0.86–1.03) | |||
Former smokers (quit within the last 8 years) |
1.12 (1.08–1.16)
| 1.03 (0.91–1.15) | |||
Weight | Normal weight | 1.00 | 1.00 | ||
Underweight |
1.29 (1.18–1.40)
| 1.24 (0.97–1.57) | |||
Overweight |
0.92 (0.89–0.95)
| 1.02 (0.92–1.13) | |||
Obese | 0.99 (0.96–1.02) |
1.16 (1.06–1.27)
| |||
Comorbidities | Diabetes |
1.32 (1.29–1.36)
|
1.22 (1.11–1.35)
| ||
Stroke |
1.30 (1.27–1.34)
|
1.25 (1.13–1.39)
| |||
Infarction |
1.51 (1.46–1.57)
|
1.16 (1.01–1.34)
| |||
Cancer |
1.38 (1.35–1.42)
|
1.27 (1.16–1.39)
| |||
Arthritis |
1.19 (1.15–1.23)
|
1.22 (1.07–1.39)
|
GOLD grade 1 | GOLD grade 2 | GOLD grade 3 | GOLD grade 4 | |||||
---|---|---|---|---|---|---|---|---|
N
| Mean (CI 95%) |
N
| Mean (CI 95%) |
N
| Mean (CI 95%) |
N
| Mean (CI 95%) | |
Total direct costs | 12,053 (30.7%) | €3809 [€3691–€3935] | 18,119 (46.1%) |
€4284 [€4176–€4394]***
| 7383 (18.8%) |
€5548 [€5328–€5774]***
| 1752 (4.5%) |
€8309 [€7583–€9065]***
|
Ambulatory costs | 12,053 (30.7%) | €553 [€533–€574] | 18,119 (46.1%) |
€601 [€579–€623]***
| 7383 (18.8%) | €588 [€558–€621] | 1752 (4.5%) | €579 [€511–€662] |
Medication costs | 12,053 (30.7%) | €594 [€571–€619] | 18,119 (46.1%) |
€716 [€688–€746]***
| 7383 (18.8%) |
€930 [€877–€994]***
| 1752 (4.5%) |
€1486 [€1176–€1862]***
|
Hospitalization | 12,053 (30.7%) | €2045 [€1946–€2147] | 18,119 (46.1%) |
€2268 [€2184–€2354]***
| 7383 (18.8%) |
€3000 [€2836–€3169]***
| 1752 (4.5%) |
€4272 [€3819–€4711]***
|
Rehabilitation costs | 12,053 (30.7%) | €128 [€116–€141] | 18,119 (46.1%) |
€145 [€134–€157]*
| 7383 (18.8%) |
€179 [€160–€201]***
| 1752 (4.5%) |
€259 [€215–€305]***
|
Remedies | 12,053 (30.7%) | €400 [€384–€417] | 18,119 (46.1%) |
€427 [€413–€442]*
| 7383 (18.8%) |
€609 [€579–€640]***
| 1752 (4.5%) |
€1068 [€978–€1158]***
|
Travel costs | 12,053 (30.7%) | €113 [€105–€122] | 18,119 (46.1%) |
€130 [€186–€214]**
| 7383 (18.8%) |
€200 [€186–€214]***
| 1752 (4.5%) |
€321 [€279–€366]***
|
Total indirect costs | 3705 (31.0%) | €11,784 [€11,257–€12,318] | 5473 (45.7%) |
€12,985 [€12,531–€13,443]**
| 2160 (18.1%) |
€15,805 [€15,034–€16,584]***
| 632 (5.3%) |
€19,402 [€17,853–€21,017]***
|
Sick day costs | 3705 (31.0%) | €2941 [€2750–€3132] | 5473 (45.7%) | €3162 [€2984–€3344] | 2160 (18.1%) | €3256 [€2975–€3534] | 632 (5.3%) | €3195 [€2633–€3806] |
Premature retirement costs | 3705 (31.0%) | €9105 [€8622–€9575] | 5473 (45.7%) |
€9762 [€9361–€10,159]*
| 2160 (18.1%) |
€12,247 [€11,582–€12,919]***
| 632 (5.3%) |
€15,634 [€14,390–€16,901]***
|
GOLD grade 1 | GOLD grade 2 | GOLD grade 3 | GOLD grade 4 | |||||
---|---|---|---|---|---|---|---|---|
N
| Mean (CI 95%) |
N
| Mean (CI 95%) |
N
| Mean (CI 95%) |
N
| Mean (CI 95%) | |
Total direct costs | 12,053 (30.7%) | €3828 [€3706–€3954] | 18,119 (46.1%) |
€4295 [€4185–€4407]***
| 7383 (18.8%) |
€5540 [€5323–€5769]***
| 1752 (4.5%) |
€8779 [€7982–€9649]***
|
Ambulatory costs | 12,053 (30.7%) | €554 [€533–€577] | 18,119 (46.1%) |
€597 [€575–€619]**
| 7383 (18.8%) |
€595 [€566–€626]*
| 1752 (4.5%) | €615 [€546–€697] |
Medication costs | 12,053 (30.7%) | €590 [€568–€613] | 18,119 (46.1%) |
€718 [€690–€748]***
| 7383 (18.8%) |
€939 [€888–€1001]***
| 1752 (4.5%) |
€1498 [€1208–€1852]***
|
Hospitalization | 12,053 (30.7%) | €2068 [€1969–€2170] | 18,119 (46.1%) |
€2271 [€2189–€2355]**
| 7383 (18.8%) |
€2943 [€2784–€3112]***
| 1752 (4.5%) |
€4316 [€3850–€4781]***
|
Rehabilitation costs | 12,053 (30.7%) | €126 [€113–€138] | 18,119 (46.1%) |
€145 [€134–€156]*
| 7383 (18.8%) |
€183 [€163–€205]***
| 1752 (4.5%) |
€275 [€226–€325]***
|
Remedies | 12,053 (30.7%) | €394 [€378–€411] | 18,119 (46.1%) |
€421
[€407–€435]*
| 7383 (18.8%) |
€632 [€601–€664]***
| 1752 (4.5%) |
€1185 [€1086–€1287]***
|
Travel costs | 12,053 (30.7%) | €114 [€106–€123] | 18,119 (46.1%) |
€131 [€123–€138]**
| 7383 (18.8%) |
€196 [€183–€210]***
| 1752 (4.5%) |
€319 [€278–€361]***
|
Total indirect costs | 3705 (31.0%) | €11,739 [€11,208-12,280] | 5473 (45.7%) |
€12,984 [€12,523–€13,443]***
| 2160 (18.1%) |
€16,117 [€15,312–€16,922]***
| 632 (5.3%) |
€20,525 [€18,822–€22,287]***
|
Sick day costs | 3705 (31.0%) | €2983 [€2789–€3183] | 5473 (45.7%) | €3145 [€2968-33,329€] | 2160 (18.1%) | €3210 [€2924–€3496] | 632 (5.3%) | €3255 [€2668–€3900] |
Premature retirement costs | 3705 (31.0%) | €8972 [€8497–€9449] | 5473 (45.7%) |
€9715 [€9315–€10,108]*
| 2160 (18.1%) |
€12,449 [€11,792–€13,130]***
| 632 (5.3%) |
€16.180 [€14,936–€17.443]***
|