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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
ERJ Open Research 2021 7: 00415-2021; DOI: 10.1183/23120541.00415-2021
David C. Currow
1IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
2Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
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  • For correspondence: David.Currow@uts.edu.au
Sungwon Chang
1IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
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Magnus Ekström
1IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
3Dept of Clinical Sciences, Division of Respiratory Medicine and Allergology, Lund University, Lund, Sweden
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  • ORCID record for Magnus Ekström
Ann Hutchinson
2Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
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Tim Luckett
1IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
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Slavica Kochovska
1IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
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Phillipa Hay
4Translational Health Research Institute, School of Medicine, Western Sydney University, Penrith South, NSW, Australia
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Stephen Touyz
5School of Psychology, University of Sydney, Camperdown, NSW, Australia
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Eleonora Dal Grande
6University of Adelaide, Adelaide, SA, Australia
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Miriam J. Johnson
1IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
3Dept of Clinical Sciences, Division of Respiratory Medicine and Allergology, Lund University, Lund, Sweden
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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.

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  • 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 monthsp-valueInpatient care in the previous 3 monthsp-valueTotal
    None≥1None≥1
    Subjects770 (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)<0.00147.0 (32.0–62.0)55.5 (39.6–68.0)<0.00148.0 (32.0–63.0)
    Sex<0.0010.3
     Male468 (33.0)951 (67.0)1322 (93.2)97 (6.8)1419 (49.0)
     Female302 (20.4)1177 (79.6)1394 (94.3)85 (5.7)1479 (51.0)
    Australia bornf0.50.7
     Yes548 (26.2)1541 (73.8)1955 (93.6)134 (6.4)2089 (72.1)
     No222 (27.5)585 (72.5)759 (94.1)48 (5.9)807 (27.9)
    Highest level of education##0.040.6
     School295 (28.4)743 (71.6)969 (93.4)69 (6.6)1038 (35.9)
     Trade, apprenticeship, certificate, diploma/degree or higher475 (25.6)1381 (74.4)1743 (93.9)113 (6.1)1856 (64.1)
    Work status¶¶<0.0010.004
     Working full or part-time, self employed513 (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++0.0030.07
     Married/de facto454 (24.7)1382 (75.3)1709 (93.1)127 (6.9)1836 (63.4)
     Separated, divorced, widowed, never married315 (29.8)743 (70.2)1003 (94.8)55 (5.2)1058 (36.6)
    Region of residence0.021.0
     Metropolitan547 (25.4)1607 (74.6)2018 (93.7)136 (6.3)2154 (74.3)
     Non-metropolitan223 (30.0)521 (70.0)697 (93.7)47 (6.3)744 (25.7)
    Socioeconomic indexes for area quintile0.20.2
     1 (most disadvantaged)203 (26.8)554 (73.2)702 (92.7)55 (7.3)757 (26.1)
     2139 (24.8)421 (75.2)515 (92.1)44 (7.9)559 (19.3)
     3158 (29.8)373 (70.2)502 (94.4)30 (5.6)532 (18.4)
     4135 (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
     0741 (28.0)1902 (72.0)2496 (94.4)147 (5.6)2643 (91.2)
     127 (15.6)146 (84.4)158 (91.3)15 (8.7)173 (6.0)
     2–42 (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)
      mMRCUnadjustedAdjusted¶UnadjustedAdjusted+
      0RefRefRefRef
      12.1 (1.4–3.2)1.8 (1.1–2.9)1.6 (0.9–2.8)1.4 (0.8–2.6)
      2–418.3 (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)
        mMRCUnadjustedAdjusted¶UnadjustedAdjusted+UnadjustedAdjusted§
        0RefRefRefRefRefRef
        12.1 (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)
        2–418.5 (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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        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
        ERJ Open Research Oct 2021, 7 (4) 00415-2021; DOI: 10.1183/23120541.00415-2021

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        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
        ERJ Open Research Oct 2021, 7 (4) 00415-2021; DOI: 10.1183/23120541.00415-2021
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