Health service utilisation associated with chronic breathlessness: random population sample

David C. Currow; Sungwon Chang; Magnus Ekström; Ann Hutchinson; Tim Luckett; Slavica Kochovska; Phillipa Hay; Stephen Touyz; Eleonora Dal Grande; Miriam J. Johnson

doi:10.1183/23120541.00415-2021

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FIGURE 1
Health service utilisation in the previous 3 months by self-reported chronic breathlessness in a random sample of the population of South Australia from face-to-face interviews (n=2898). mMRC: modified Medical Research Council breathlessness scale; GP: general practitioner.

TABLE 1

Demographics of adult respondents by health service utilisation of a random sample of the people of South Australia from face-to-face interviews (n=2898)

	Outpatient^# care in the previous 3 months		p-value	Inpatient care in the previous 3 months		p-value	Total
	None	≥1	p-value	None	≥1	p-value
Subjects	770 (26.6)	2128 (73.4)		2716 (93.7)	182 (6.3)		2898 (100)
Age years, median (IQR)	41.0 (27.0–53.0)	52.1 (34.0–66.0)	<0.001	47.0 (32.0–62.0)	55.5 (39.6–68.0)	<0.001	48.0 (32.0–63.0)
Sex			<0.001			0.3
Male	468 (33.0)	951 (67.0)		1322 (93.2)	97 (6.8)		1419 (49.0)
Female	302 (20.4)	1177 (79.6)		1394 (94.3)	85 (5.7)		1479 (51.0)
Australia born^f			0.5			0.7
Yes	548 (26.2)	1541 (73.8)		1955 (93.6)	134 (6.4)		2089 (72.1)
No	222 (27.5)	585 (72.5)		759 (94.1)	48 (5.9)		807 (27.9)
Highest level of education^##			0.04			0.6
School	295 (28.4)	743 (71.6)		969 (93.4)	69 (6.6)		1038 (35.9)
Trade, apprenticeship, certificate, diploma/degree or higher	475 (25.6)	1381 (74.4)		1743 (93.9)	113 (6.1)		1856 (64.1)
Work status^¶¶			<0.001			0.004
Working full or part-time, self employed	513 (32.0)	1091 (68.0)		1522 (94.9)	82 (5.1)		1604 (55.4)
Not working (home duties, unemployed, retired, student, other)	257 (19.9)	1034 (80.1)		1191 (92.3)	100 (7.7)		1291 (44.6)
Living arrangements⁺⁺			0.003			0.07
Married/de facto	454 (24.7)	1382 (75.3)		1709 (93.1)	127 (6.9)		1836 (63.4)
Separated, divorced, widowed, never married	315 (29.8)	743 (70.2)		1003 (94.8)	55 (5.2)		1058 (36.6)
Region of residence			0.02			1.0
Metropolitan	547 (25.4)	1607 (74.6)		2018 (93.7)	136 (6.3)		2154 (74.3)
Non-metropolitan	223 (30.0)	521 (70.0)		697 (93.7)	47 (6.3)		744 (25.7)
Socioeconomic indexes for area quintile			0.2			0.2
1 (most disadvantaged)	203 (26.8)	554 (73.2)		702 (92.7)	55 (7.3)		757 (26.1)
2	139 (24.8)	421 (75.2)		515 (92.1)	44 (7.9)		559 (19.3)
3	158 (29.8)	373 (70.2)		502 (94.4)	30 (5.6)		532 (18.4)
4	135 (23.9)	431 (76.1)		536 (94.5)	31 (5.5)		567 (19.6)
5 (most advantaged)	135 (28.0)	348 (72.0)		460 (95.2)	23 (4.8)		483 (16.7)
Body mass index (BMI)^§§			<0.001			<0.001
Not overweight^¶	354 (32.4)	738 (67.6)		1035 (94.8)	57 (5.2)		1092 (40.0)
Overweight⁺	259 (26.7)	710 (73.3)		919 (94.8)	50 (5.2)		969 (35.5)
Obese^§	102 (15.3)	565 (84.7)		602 (90.3)	65 (9.7)		667 (24.5)
mMRC	<0.001		<0.001			<0.001
0	741 (28.0)	1902 (72.0)		2496 (94.4)	147 (5.6)		2643 (91.2)
1	27 (15.6)	146 (84.4)		158 (91.3)	15 (8.7)		173 (6.0)
2–4	2 (2.4)	80 (97.6)		62 (75.6)	20 (24.4)		82 (2.8)

Data expressed as n (%) unless otherwise noted. mMRC: modified Medical Research Council breathlessness scale. ^#: includes visits to general practice or specialist (other than mental health specialist) or presentation to the emergency department; ^¶: non-overweight weight category includes underweight (BMI ≤18.5 kg·m⁻², n=50; 1.7% of cohort); ⁺: BMI >25, ≤30 kg·m⁻²; ^§: BMI >30 kg·m⁻²; “not stated” for ^f: n = 2; ^##: n = 4; ^¶¶: n = 3; ⁺⁺: n = 4; ^§§: 170.

TABLE 2

Unadjusted and adjusted odds ratios (95% confidence intervals) for severity of chronic breathlessness as correlates of health service utilisation (outpatient^# care and inpatient care) in the previous 3 months

	Outpatient^# care OR (95% CI)		Inpatient care OR (95% CI)
mMRC	Unadjusted	Adjusted^¶	Unadjusted	Adjusted⁺
0	Ref	Ref	Ref	Ref
1	2.1 (1.4–3.2)	1.8 (1.1–2.9)	1.6 (0.9–2.8)	1.4 (0.8–2.6)
2–4	18.3 (4.0–83.6)	9.0 (2.0–41.5)	5.5 (3.2–9.2)	4.2 (2.4–7.4)

mMRC: modified Medical Research Council breathlessness scale. ^#: includes visits to general practice or specialist (other than mental health specialist) or presentation to the emergency department; ^¶: adjusted for age, sex, body mass index (BMI), highest level of education, region of residence; ⁺: adjusted for age, sex and BMI.

TABLE 3

Unadjusted and adjusted odds ratios (95% confidence intervals) for severity of chronic breathlessness as correlates of any medical consultation, frequent medical consultations and any emergency department contact in the previous 3 months

	Any medical consultation OR (95% CI)		Frequent^# (≥3) medical consultations OR (95% CI)		Any emergency department visits OR (95% CI)
mMRC	Unadjusted	Adjusted^¶	Unadjusted	Adjusted⁺	Unadjusted	Adjusted^§
0	Ref	Ref	Ref	Ref	Ref	Ref
1	2.1 (1.4–3.3)	1.8 (1.1–3.0)	2.4 (1.7–3.3)	1.8 (1.3–2.6)	1.3 (0.8–2.2)	1.0 (0.5–1.8)
2–4	18.5 (4.1–84.7)	9.1 (2.0–42.1)	7.2 (4.6–11.4)	4.6 (2.8–7.5)	4.1 (2.4–7.0)	3.6 (2.0–6.3)

mMRC: modified Medical Research Council breathlessness scale. ^#: includes visits to general practice or specialist (other than mental health specialist) or presentation to emergency department; ^¶: adjusted for age, sex, highest level of education, region of residence and body mass index (BMI); ⁺: adjusted for age, sex, region of residence and BMI; ^§: adjusted for age, sex and BMI.

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Supplementary material 00415-2021.SUPPLEMENT