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Abstract
Background It is well described that there is social inequality in the disease course of chronic obstructive pulmonary disease (COPD), but the impact of social relations is less explored. We aimed to investigate the impact of adult offspring and their educational level on readmission and death among older adults with COPD.
Methods In total, 71 084 older adults born 1935–53 with COPD diagnosed at age ≥65 years in 2000–2018 were included. Multistate survival models were performed to estimate the impact of adult offspring (offspring (reference) vs no offspring) and their educational level (low, medium or high (reference)) on the transition intensities between three states: COPD diagnosis, readmission and all-cause death.
Results During follow-up, 29 828 (42.0%) had a readmission and 18 504 (26.0%) died with or without readmission. Not having offspring was associated with higher hazards of death without readmission (HRwomen: 1.52 (95% CI: 1.39 to 1.67), HRmen: 1.29 (95% CI: 1.20 to 1.39)) and a higher hazard of death after readmission for women only (HRwomen: 1.19 (95% CI: 1.08 to 1.30). Having offspring with low educational level was associated with higher hazards of readmission (HRwomen: 1.12 (95% CI: 1.06 to 1.19)), (HRmen: 1.06 (95%CI: 1.002 to 1.12)), death without readmission (HRwomen: 1.24 (95% CI: 1.11 to 1.39)), HRmen: 1.16 (95% CI: 1.05 to 1.29) and death after readmission for men only (HRmen: 1.15 (95% CI: 1.05 to 1.25)). Having offspring with medium educational level was associated with a higher hazard of death without readmission for women (HRwomen: 1.11 (95% CI: 1.02 to 1.21)).
Conclusion Adult offspring and their educational level were associated with higher risk of readmission and death among older adults with COPD.
- SOCIAL CAPITAL
- COHORT STUDIES
- EPIDEMIOLOGY
- GERONTOLOGY
- HEALTHCARE DISPARITIES
Data availability statement
Data may be obtained from a third party and are not publicly available. In this study we have used data from Statistics Denmark. To access the anonymised dataset used in this study, researchers need to apply to Statistics Denmark. Only aggregated data, where no identification of persons is possible i.e. minimum five observations in each cell, can be removed from the server containing the data accessed through Statistics Denmark. Thus, we cannot provide an anonymised copy of the dataset as individuals may be identified based on the information in the data. Access to the data through Statistics Denmark is only granted for authorised research and analysis environments of a more permanent nature with a chief researcher and several researchers/analysts. Foreign researchers affiliated to a Danish authorised environment can also get access. Authorisation is granted by the Director General. Please find more information in the document 'Access to micro data at Statistics Denmark_2014' on https://www.dst.dk/en/TilSalg/Forskningsservice.
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Data availability statement
Data may be obtained from a third party and are not publicly available. In this study we have used data from Statistics Denmark. To access the anonymised dataset used in this study, researchers need to apply to Statistics Denmark. Only aggregated data, where no identification of persons is possible i.e. minimum five observations in each cell, can be removed from the server containing the data accessed through Statistics Denmark. Thus, we cannot provide an anonymised copy of the dataset as individuals may be identified based on the information in the data. Access to the data through Statistics Denmark is only granted for authorised research and analysis environments of a more permanent nature with a chief researcher and several researchers/analysts. Foreign researchers affiliated to a Danish authorised environment can also get access. Authorisation is granted by the Director General. Please find more information in the document 'Access to micro data at Statistics Denmark_2014' on https://www.dst.dk/en/TilSalg/Forskningsservice.
Footnotes
Twitter @mathilde_sloth, @EmmaNebleLarsen, @TereseHoej
Contributors All authors have approved the final article. TSHJ, MMBS and ENL have full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analyses. Study concept: TSHJ, MO, MMBS and ENL. Study design: TSHJ, NSG, MO, MMBS and ENL. Acquisition of data: TSHJ. Statistical analysis: MMBS. Interpretation of results: all authors. Drafting of the manuscript: MMBS. Critical revision of the manuscript for important intellectual content: all authors. Guarantor: MMBS.
Funding TSHJ, MMBS and ENL were supported by Helsefonden (grant no 18-B-0026) and the Danish Heart Foundation (no A8374).
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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