Socioeconomic Status Related to Prescription of Triple Therapy and Anticholinergic Monotherapy in Patients with Chronic Obstructive Pulmonary Disease (COPD) in Sweden - A Retrospective National Registry Study.

Purpose: There is an association between low socioeconomic status and chronic obstructive pulmonary disease (COPD), but it is not known whether this impacts on drug prescription for COPD treatment. The aim of the study was to explore whether drug prescription differs between COPD patients with low and high socioeconomic status. Patients and methods: Data from patients with incident and prevalent COPD (age>40 years), without an asthma diagnosis, visiting primary care in 2021-2022 were extracted from The Swedish National Airway Register (SNAR) and linked to Swedish National Health registries. Socioeconomic status was assessed by educational level and annual income. Statistical analyses were conducted by means of chi square tests, together with post-hoc test. Results: In total, 38692 patients (mean age 73.6 years, 55.5% women, FEV1 59.5% of predicted value) were included. Subdivision into GOLD group A, B and E was possible in 29128 patients. Triple therapy (long-acting antimuscarinic antagonists, LAMA + long-acting beta-2-agonist, LABA + inhaled steroids, ICS), was more often prescribed in the low education group (observed/expected ratio 1.09; p<0.0001) and low income group (ratio 1.05; p<0.05) and less often in the high education group (ratio 0.87; p<0.0001) and high income group (ratio 0.88; p<0.0001). Monotherapy (LAMA) was more often prescribed in patients with high income (ratio 1.09; p<0.0001) and less often in patients with low income (ratio 0.93; p=0.0004). Differences between high and low education and income were driven by differences in group B. Conclusion: Prescription patterns were associated with small, statistically significant differences, between COPD patients with low and high socioeconomic status. Triple therapy was more often prescribed to patients with low socioeconomic status, and monotherapy with LAMA more often to patients with high. The reason for this is not clear but may be caused by differences in exacerbation rate between the socioeconomic groups.