PMID- 29020525
OWN - NLM
STAT- MEDLINE
DCOM- 20180724
LR  - 20181113
IS  - 1541-2563 (Electronic)
IS  - 1541-2555 (Print)
IS  - 1541-2563 (Linking)
VI  - 14
IP  - 6
DP  - 2017 Dec
TI  - Social Determinants of Adherence to Pulmonary Rehabilitation for Chronic 
      Obstructive Pulmonary Disease.
PG  - 610-617
LID - 10.1080/15412555.2017.1379070 [doi]
AB  - Adherence to pulmonary rehabilitation (PR) is low. Previous studies have focused 
      on clinical predictors of PR completion. We aimed to identify social determinants 
      of adherence to PR. A cross-sectional analysis of a database of COPD patients (N 
      = 455) in an outpatient PR program was performed. Adherence, a ratio of 
      attended-to-prescribed sessions, was coded as low (<35%), moderate (35-85%), and 
      high (>85%). Individual-level measures included age, sex, race, BMI, smoking 
      status, pack-years, baseline 6-minute walk distance (6MWD: <150, 150-249, >/=250), 
      co-morbidities, depression, and prescribed PR sessions (</=20, 21-30, >30). Fifteen 
      area-level measures aggregated to Census tracts were obtained from the U.S. 
      Census after geocoding patients' addresses. Using exploratory factor analysis, a 
      neighborhood socioeconomic disadvantage index was constructed, which included 
      variables with factor loading >0.5: poverty, public assistance, households 
      without vehicles, cost burden, unemployment, and minority population. 
      Multivariate regression models were adjusted for clustering on Census tracts. 
      Twenty-six percent of patients had low adherence, 23% were moderately adherent, 
      51% were highly adherent. In the best fitted full model, each decile increase in 
      neighborhood socioeconomic disadvantage increased the risk of moderate vs high 
      adherence by 14% (p < 0.01). Smoking tripled the relative risk of low adherence 
      (p < 0.01), while each increase in 6MWD category decreased that risk by 72% (p < 
      0.01) and 84% (p < 0.001), respectively. These findings show that, relative to 
      high adherence, low adherence is associated with limited functional capacity and 
      current smoking, while moderate adherence is associated with socioeconomic 
      disadvantage. The distinction highlights different pathways to suboptimal 
      adherence and calls for tailored intervention approaches.
FAU - Oates, Gabriela R
AU  - Oates GR
AUID- ORCID: 0000-0003-4052-1524
AD  - a Preventive Medicine , University of Alabama at Birmingham , Birmingham , AL , 
      USA.
FAU - Hamby, Bryant W
AU  - Hamby BW
AD  - b Sociology , University of Alabama at Birmingham , Birmingham , AL , USA.
FAU - Stepanikova, Irena
AU  - Stepanikova I
AD  - b Sociology , University of Alabama at Birmingham , Birmingham , AL , USA.
FAU - Knight, Sara J
AU  - Knight SJ
AD  - a Preventive Medicine , University of Alabama at Birmingham , Birmingham , AL , 
      USA.
AD  - c Birmingham Veterans Affairs Medical Center , Birmingham , AL , USA.
FAU - Bhatt, Surya P
AU  - Bhatt SP
AD  - d Lung Health Center and Pulmonary, Allergy and Critical Care Medicine , 
      University of Alabama at Birmingham , Birmingham , AL , USA.
FAU - Hitchcock, Jason
AU  - Hitchcock J
AD  - e Cardiopulmonary Rehabilitation , University of Alabama at Birmingham , 
      Birmingham , AL , USA.
FAU - Schumann, Christopher
AU  - Schumann C
AD  - e Cardiopulmonary Rehabilitation , University of Alabama at Birmingham , 
      Birmingham , AL , USA.
FAU - Dransfield, Mark T
AU  - Dransfield MT
AD  - c Birmingham Veterans Affairs Medical Center , Birmingham , AL , USA.
AD  - d Lung Health Center and Pulmonary, Allergy and Critical Care Medicine , 
      University of Alabama at Birmingham , Birmingham , AL , USA.
LA  - eng
GR  - K12 HS023009/HS/AHRQ HHS/United States
PT  - Journal Article
DEP - 20171011
PL  - England
TA  - COPD
JT  - COPD
JID - 101211769
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Comorbidity
MH  - Cost of Illness
MH  - Cross-Sectional Studies
MH  - Depression/psychology
MH  - Factor Analysis, Statistical
MH  - Female
MH  - Humans
MH  - Logistic Models
MH  - Male
MH  - Middle Aged
MH  - Minority Groups/*statistics & numerical data
MH  - Motor Vehicles/statistics & numerical data
MH  - Multivariate Analysis
MH  - Patient Compliance/*statistics & numerical data
MH  - Poverty/*statistics & numerical data
MH  - Public Assistance/*statistics & numerical data
MH  - Pulmonary Disease, Chronic Obstructive/epidemiology/psychology/*rehabilitation
MH  - Residence Characteristics
MH  - Respiratory Therapy/*statistics & numerical data
MH  - Smoking/epidemiology
MH  - *Social Class
MH  - Social Determinants of Health
MH  - Unemployment/*statistics & numerical data
MH  - United States
MH  - Walk Test
PMC - PMC5830088
MID - NIHMS944774
OTO - NOTNLM
OT  - adherence
OT  - pulmonary rehabilitation
OT  - social determinants
OT  - socioeconomic disadvantage
COIS- Declaration of interest: The authors report no conflicts of interest. The content 
      is the responsibility of the authors and does not necessarily represent the 
      official views of the Agency for Healthcare Research and Quality.
EDAT- 2017/10/12 06:00
MHDA- 2018/07/25 06:00
PMCR- 2018/02/28
CRDT- 2017/10/12 06:00
PHST- 2017/10/12 06:00 [pubmed]
PHST- 2018/07/25 06:00 [medline]
PHST- 2017/10/12 06:00 [entrez]
PHST- 2018/02/28 00:00 [pmc-release]
AID - 10.1080/15412555.2017.1379070 [doi]
PST - ppublish
SO  - COPD. 2017 Dec;14(6):610-617. doi: 10.1080/15412555.2017.1379070. Epub 2017 Oct 
      11.