1. What is the association between Chronic Obstructive
Pulmonary Disease (COPD) and Health-Related
Quality of Life in Manchester in 2011?
Beaumont-Kellner H, Frank T, Caress A. (2012)
School of Nursing and Midwifery, University of Manchester, UK.
Introduction
This study examines the association between COPD
and health-related quality of life (HRQoL) in Manchester
in 2011 using a generic health-related quality of life
questionnaire and was part of a Masters in Clinical
Research.
The study formed part of a larger primary care study,
which covered 20 general practices in Greater
Manchester. This number of practices will yield a large
volume of responses; therefore, a smaller sub group of
COPD and comparator patients from six practices is
used for this MClin Res project.
It is evident in the literature that there is no recent
information on this group of patients in the UK.
Confounding variables such as age, socioeconomic
status, demographics and co-morbidity in this sample
are also discussed.
This quantitative cross-sectional questionnaire
comparator study collected data from six practices
using the EQ-5D and EQ-5Dvas from a primary care
patient population with COPD and co-morbidity.
Patients were identified from the practice QOF registers
using Apollo Medical software (read codes are supplied
to Apollo Medical and anonymous data is extracted and
matched up with the completed patient questionnaire)
or manually by the author.
A 5% randomly selected of patients aged 16 years and
over without a chronic condition were included in the
comparator group. An alert was put on each patient
record to assist GPs and nurses at the practice to avoid
opportunistic comparator group sampling. HRQoL was
measured and analysed alongside demographic
information, which was supplied by the patient. Data
was collected over a six-month period.
54 (85.7%) of the responders with COPD in the sample
either smoked (or were ex-smokers) compared to the
comparator group (10.1%).
Nine responders (14.3%) in the COPD sample reported
being a non-smoker.
The highest and lowest reported health state score, ‘0’
being the worst health state and ‘100’ being the best
health state.
The mean score for the COPD group was 62.05, SD =
19.12 and 56 out of 63 patients completed this section
of the questionnaire. The 95% CI of mean shows
patients reported a score between 56.93 and 67.18.
The mean score for the comparator group was 75.76,
SD = 20.251, and 21/25 patients completed this
section of the questionnaire. The 95% CI of mean
shows patients reported a score of 66.54 to 84.98
This study contributes to current literature, by
supporting and validating previous arguments.
COPD patients in Manchester had a lower health
state compared to the comparator group, and
responders with COPD were more likely to smoke
and did not complete further education over the
age of 16 years.
These results emphasize the importance of
individual patient experience, their perceived
health state and the need to continually improve
disease management by applying HRQoL
measurements.
However, limitations of the study results include
the small sample size and confounding variables
such as age.
EuroQol Group (1990) EuroQol – a new facility for the measurement of
health-related quality of life. Health Policy, 16:199-208.
Henquet C, Krabbendam L, Spauwen J, Kaplan C, Lieb R, Wittchen H, Van Os
J (2005) Prospective cohort study of cannabis use, predisposition for
psychosis and psychotic symptoms in young people. BMJ; 330: 11-4.
Machin D, Campbell MJ, Walters SJ (2007) Medical Statistics: A textbook for
the health sciences. 4th
Ed. Wiley, England.
Conclusion
This study did not find any significant association
between the two groups reporting on EQ5D index
scores.
This may be due to the low numbers of the population.
The author therefore recommends further study in to
this research question, which would also establish
patient reported outcomes for the GP practices and
assist in the management of COPD.
Recommendations
References
I would like to acknowledge my clinical and academic
supervisors Dr Tim Frank and Professor Ann Caress,
University Hospital of South Manchester (UHSM).
Acknowledgement
Table 2: Extreme EQ5D-vas health state
scores reported from both groups.
Figure1: Box and whisker plot for COPD
and comparator group vas scores
Statistical analysis was used to test the null hypothesis
of no association between HRQoL and COPD, using
the Chi-squared test for association and Fishers Exact
on categorical ordinal data. To look for a difference
between the two groups the Mann-Whitney U test and
Wilcoxon test were used due to the non-normal
distribution of the data (Machin et al., 2007).
88 patients with COPD or in the comparator group were
selected from the total sample (n=1000). Current or
ex-smokers were more likely to have COPD
(p=0.0001). Patients with COPD reported a lower
‘health state’ score compared to the comparator group
using the EQ-5Dvas (p=0.007). In addition there was a
significant association between education after the age
of 16 years and COPD (p=0.0008).
Figure 1 shows that the median score for the COPD
group on health state that day was lower than the
comparator group. The COPD data is also skewed to
the left (Bland, 1995).
(Mann Whitney U = 353.500, P = 0.007).
This is confirmed with the significant p value; rejecting
the H0 showing evidence that there is an association
between COPD and comparator health state scores.
The box and whiskers plot above shows outliers in
the comparator group.
The Pearson Chi-square test was applied as cell counts
are above 5; the significant results ( ² = 6.947, df=1,
p=0.008) supports the alternative hypothesis of an
association between further education and COPD.
The Pearson Chi-Square test shows a significant p value
( ²= 9.567, df=1, p=0.002), rejecting the null hypothesis
that there is no association between a degree level of
education and a COPD diagnosis. The odds ratio of
COPD for patients with no degree is 4.9, which is a high
odds outcome (Henquet et al., 2005).
In Table 5 above, hypertension, CHD and stroke have
been grouped together as CVD. In the sample this
shows that 49 patients (55.1%) with COPD also had a
cardiovascular disease.
Table 3: Education, 16 years and over –
COPD and comparator group (n=88)
Table 4: Degree level of education in
COPD and comparator sample (n=88)
Table 5: Co-morbidity in COPD group
100
80
60
40
COPD Comparator
16
20
VAS0-99
28
Methods
Results
median = 60
IQR = 29
median = 80
IQR = 24
Table 1: Cross-tabulation of COPD and
comparator smoking status
Smoking status COPD Comparator Total
Count 15 1 16
Current
% COPD AND
smoker
Comparator
23.8% 4.0% 18.2%
Count 39 8 47
Ex-
% COPD AND
smoker
Comparator
61.9% 32.0% 53.4%
Count 9 16 25
Non-
% COPD AND
smoker
Comparator
14.3% 64.0% 28.4%
Count 63 25 88
Total % COPD AND
Comparator
100.0% 100.0% 100.0%
Manchester
Stockport
Tameside
Bolton
Salford
Wigan
Trafford
Oldham
RochdaleBury
Education COPD Comparator Total
Count 14 13 27
Yes % COPD AND
Comparator
23.0% 52.0% 31.4%
Count 47 12 59
No % COPD AND
Comparator
77.0% 48.0% 68.6%
Count 61 25 86
Total % COPD AND
Comparator
100.0% 100.0% 100.0%
COPD AND comparator Case Value
Health state scores Number VAS 0-99
COPD Highest 1 35 100
2 34 97
3 33 90
4 61 90
5 88 90
Lowest 1 85 20
2 83 20
3 86 30
4 66 30
5 80 40
Comparator Highest 1 9 100
2 21 100
3 8 92
4 4 90
5 5 90
Lowest 1 23 30
2 16 38
3 1 4
4 2 50
5 20 56
Degree COPD Comparator Total
Count 10 12 22
Yes % COPD AND
Comparator
16.9% 50.0% 26.5%
Count 49 12 61
No % COPD AND
Comparator
83.1% 50.0% 73.5%
Count 59 24 83
Total % COPD AND
Comparator
100.0% 100.0% 100.0%
Co-morbidity COPD Count (%)
CVD 27 (55.1%)
Asthma 8 (16.3%)
Diabetes 8 (16.3%)
Hyperthyroid 6 (12.2%)
Total 49 (100%)
Emphysema
AsthmaChronic
bronchitis
COPD