Abstract
Introduction and Objectives
Deprivation is strongly linked to COPD, exacerbations (ECOPD), hospitalisation and poor outcome. The non-invasive ventilation (NIV) outcomes score directed weaning trial (NIVOW: ISRCTN64639614) is a 7-centre RCT comparing two weaning regimes. We explored the impact of deprivation within the study population.
Methods
Deprivation was assessed using the Index of Multiple Deprivation (IMD) and distribution by decile captured from the most (IMD 1) to least (IMD 10) deprived. Univariate and independent associates were identified, and potential influence of deprivation on length of stay during the index admission (LoS), 30-day readmissions, secondary care review for COPD, and in-hospital and 90-day mortality explored.
Results
84/164 (51.2%) participants were in decile 1–3, with 5.5 fold more participants in IMD 1 compared to IMD 10. Deprivation was associated with worse breathlessness and performance status eMRCD (ρ =-0.59, p=0.01), but better pre-NIV pH (ρ= -8.9, p = 0.04) and pre-NIV PaCO2 (ρ =0.19, ρ= 0.05), with a trend for more frequent ECOPD within the previous 12 months (ρ= -0.14, p = 0.06). Substance use was uncommon, but more prevalent among the most deprived: 7/11 (63.6%) in the lowest 3 deciles. There was no significant difference in outcomes by deprivation decile.
Conclusion
Deprivation was strongly associated with ECOPD admissions requiring NIV across 7 UK centres. Higher deprivation was associated with worse breathlessness and performance status (eMRCD), and shows a trend toward increased exacerbation frequency. There was no association with FEV1% predicted, BMI, smoking or burden of comorbidities. More deprived participants had less severe respiratory acidaemia on admission which may reflect a less severe insult on a background of poorer performance status. Deprivation had no significant association with outcomes. Respiratory admissions in winter 2022/23 were 2.2 fold higher in IMD 1 (most deprived decile) compared to IMD 10.1 In stark contrast there was a 5.5 fold difference in our population. There is an urgent need to address health inequalities in this large and disadvantaged population.
Deprivation is strongly linked to COPD, exacerbations (ECOPD), hospitalisation and poor outcome. The non-invasive ventilation (NIV) outcomes score directed weaning trial (NIVOW: ISRCTN64639614) is a 7-centre RCT comparing two weaning regimes. We explored the impact of deprivation within the study population.
Methods
Deprivation was assessed using the Index of Multiple Deprivation (IMD) and distribution by decile captured from the most (IMD 1) to least (IMD 10) deprived. Univariate and independent associates were identified, and potential influence of deprivation on length of stay during the index admission (LoS), 30-day readmissions, secondary care review for COPD, and in-hospital and 90-day mortality explored.
Results
84/164 (51.2%) participants were in decile 1–3, with 5.5 fold more participants in IMD 1 compared to IMD 10. Deprivation was associated with worse breathlessness and performance status eMRCD (ρ =-0.59, p=0.01), but better pre-NIV pH (ρ= -8.9, p = 0.04) and pre-NIV PaCO2 (ρ =0.19, ρ= 0.05), with a trend for more frequent ECOPD within the previous 12 months (ρ= -0.14, p = 0.06). Substance use was uncommon, but more prevalent among the most deprived: 7/11 (63.6%) in the lowest 3 deciles. There was no significant difference in outcomes by deprivation decile.
Conclusion
Deprivation was strongly associated with ECOPD admissions requiring NIV across 7 UK centres. Higher deprivation was associated with worse breathlessness and performance status (eMRCD), and shows a trend toward increased exacerbation frequency. There was no association with FEV1% predicted, BMI, smoking or burden of comorbidities. More deprived participants had less severe respiratory acidaemia on admission which may reflect a less severe insult on a background of poorer performance status. Deprivation had no significant association with outcomes. Respiratory admissions in winter 2022/23 were 2.2 fold higher in IMD 1 (most deprived decile) compared to IMD 10.1 In stark contrast there was a 5.5 fold difference in our population. There is an urgent need to address health inequalities in this large and disadvantaged population.
| Original language | English |
|---|---|
| Pages (from-to) | A213-A214 |
| Number of pages | 2 |
| Journal | Thorax |
| Volume | 80 |
| Issue number | 2 |
| Early online date | 2 Nov 2025 |
| DOIs | |
| Publication status | Published - Nov 2025 |
| Event | British Thoracic Society Winter Meeting 2025 - QEII Centre, London, United Kingdom Duration: 26 Nov 2025 → 28 Nov 2025 https://www.brit-thoracic.org.uk/education-and-events/winter-meeting/ |