Health inequalities in enrolment and completion of pulmonary rehabilitation: analysis of >88 000 individuals with COPD from a National Respiratory Audit Programme.

Abstract

Pulmonary rehabilitation (PR) is an effective intervention for individuals with COPD, but enrolment and completion remain challenging. The impact of determinants of health and their intersectionality on enrolment and completion is unknown.This study aimed to compare enrolment and completion of PR across determinants of health using a National Respiratory Audit Programme dataset from England and Wales. 88 446 individuals with COPD attending a PR assessment in March 2019-September 2023 were included. Enrolment was defined as attending ≥1 PR session and completion as attending a discharge assessment. Data were analysed using generalised linear mixed models with a logit link function. Covariates included age, gender, ethnicity, Medical Research Council (MRC) dyspnoea grade and Index of Multiple Deprivation (IMD) quintile. 72 085 (82%) individuals enrolled and 52 669 (60%) completed. Determinants of health with significantly lower ORs (95% CI) of enrolment and completion were age <60 years (0.46 (0.42 to 0.51); 0.46 (0.39 to 0.53), respectively), female gender (0.92 (0.86 to 0.98); 0.91 (0.88 to 0.95), respectively), MRC 5 (0.72 (0.64 to 0.82); 0.46 (0.39 to 0.54), respectively) and IMD 1 (most deprived) (0.64 (0.56 to 0.72); 0.64 (0.60 to 0.68), respectively) (p<0.01). Individuals with a Black ethnicity had significantly greater odds of enrolling and completing than individuals with a White ethnicity (OR (95% CI) 2.16 (1.46 to 3.18); 1.50 (1.24 to 1.82), respectively, p<0.01). Intersectionality influenced PR completion, but not enrolment, with age modifying the relationship between MRC grade and completion. Through the world's largest PR dataset, we report potential health inequalities in enrolling and completing PR. Strategies to improve enrolment and completion by supporting key determinants of health are urgently needed.