Co-morbidity in older patients with COPD—its impact on health service utilisation and quality of life, a community study

Abstract

Background: co-morbidity has been shown to be an important consideration in COPD with an estimated prevalence of 84%. In the Netherlands, a weak association between health-related quality of life and lung function has been found, with a closer link to co-morbidity. Objective: to determine the influence of co-morbidity on quality of life and health service utilisation in older patients with COPD in the community. Design: observational cohort study. Setting: general practice in the North East of England that has a list size of 8300. Participants: 27 patients aged 70 years or above on the practice COPD register. Measurements: data on age and sex, spirometry to confirm the diagnosis of COPD, questionnaires to assess quality of life, activities of daily living (ADLs) and co-morbidity. Health service utilisation was recorded by the number of primary and secondary care attendances in the previous year. Results: 10 had mild, 12 had moderate, and 5 had severe disease. Mean age was 76 years. Quality of life (QOL), co-morbidity and health service utilisation measurements were not significantly different between COPD severity groups. There was a significant positive correlation between increasing co-morbidity and poor QOL (r = 0.45, P < 0.05), and significant negative correlation between co-morbidity and ADL scores (scored inversely), r = -0.54, P < 0.05. Significant negative correlation was found between co-morbidity and primary care attendances (r = -0.41, P < 0.05) and significant positive correlation between worsening QOL and secondary care attendances (r = 0.46, P < 0.05). Conclusions: co-morbidity has an important part to play in COPD assessment, more accurately reflecting QOL in our population. Health service utilisation did not correlate to forced expiratory volume (FEV₁)-defined COPD severity.