Socioeconomic inequality in the use of prescription medications for smoking cessation among patients with COPD: a nationwide study

Abstract

Sandra Søgaard Tøttenborg,1 Alice Jessie Clark,1 Reimar Wernich Thomsen,2 Søren Paaske Johnsen,2 Peter Lange1,3 1Department of Public Health, Section of Social Medicine, University of Copenhagen, Copenhagen, Denmark; 2Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; 3Respiratory Section, Hvidovre Hospital, Hvidovre, Denmark Background: Bupropion and varenicline can substantially improve the chances of smoking cessation in patients with COPD, but are unsubsidized and relatively costly. We examined overall use and socioeconomic patterns of use among patients with COPD. Patients and methods: We identified 4,741 COPD patients reporting to be smokers at their first contact for COPD during 2008–2012 in the Danish register of COPD, which covers all pulmonary outpatient clinics in Denmark. Patients were followed for 6 months in the National Prescription Registry. Logistic regression analyses were used to calculate the ORs with corresponding 95% CI of redeeming a prescription for any of the smoking cessation medications in strata of baseline characteristics. Results: During 6 months from first consultation, only 5% redeemed a prescription for bupropion or varenicline. Younger age, female sex, higher education, and higher income were associated with an increased likelihood, while non-Danish ethnicity, living alone, and very severe COPD were associated with a lower likelihood of redeeming bupropion or varenicline. Conclusion: Despite their proven effectiveness, bupropion and varenicline are sparingly used among COPD patients followed in the hospital outpatient setting with the lowest use among the socioeconomically disadvantaged. This highlights a missed opportunity for intervention. Keywords: bupropion, varenicline, smoking intervention, lung disease

Keywords

• Bupropion
• Varenicline
• Smoking intervention
• socioeconomic inequality