Survival analysis of COPD patients in a 13-year nationwide cohort study of the Brazilian national health system

Ludmila Peres Gargano, Isabella de Figueiredo Zuppo, Mariana Martins Gonzaga do Nascimento, Valéria Maria Augusto, Brian Godman, Juliana de Oliveira Costa, Francisco de Assis Acúrcio, Juliana Alvares-Teodoro, Augusto Afonso Guerra Júnior

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Abstract

Background: Chronic obstructive pulmonary disease (COPD) has an appreciable socioeconomical impact in low- and middle-income countries, but most epidemiological data originate from high-income countries. For this reason, it is especially important to understand survival and factors associated with survival in COPD patients in these countries. Objective: To assess survival of COPD patients in Brazil, to identify risk factors associated with overall survival, including treatment options funded by the Brazilian National Health System (SUS). Methodology: We built a retrospective cohort study of patients dispensed COPD treatment in SUS, from 2003 to 2015 using a National Database created from the record linkage of administrative databases. We further matched patients 1:1 based on sex, age and year of entry to assess the effect of the medicines on patient survival. We used the Kaplan-Meier method to estimate overall survival of patients, and Cox's model of proportional risks to assess risk factors. Result: Thirty seven thousand and nine hundred and thirty eight patients were included. Patient's survival rates at 1 and 10 years were 97.6% (CI 95% 97.4–97.8) and 83.1% (CI 95% 81.9–84.3), respectively. The multivariate analysis showed that male patients, over 65 years old and underweight had an increased risk of death. Therapeutic regimens containing a bronchodilator in a free dose along with a fixed-dose combination of corticosteroid and bronchodilator seem to be a protective factor when compared to other regimens. Conclusion: Our findings contribute to the knowledge of COPD patients' profile, survival rate and related risk factors, providing new evidence that supports the debate about pharmacological therapy and healthcare of these patients.
Original languageEnglish
Article number788268
Number of pages22
JournalFrontiers in Pharmacology
Volume4
Early online date7 Feb 2022
DOIs
Publication statusPublished - 7 Feb 2022

Keywords

  • survival analysis
  • COPD
  • real world data
  • cohort study
  • record linkage

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