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Identification of subtypes in subjects with mild-to-moderate airflow limitation and its clinical and socioeconomic implications
- Title
- Identification of subtypes in subjects with mild-to-moderate airflow limitation and its clinical and socioeconomic implications
- Authors
- Lee J.H.; Rhee C.K.; Kim K.; Kim J.-A.; Kim S.H.; Yoo K.H.; Kim W.J.; Park Y.B.; Park H.Y.; Jung K.-S.
- Ewha Authors
- 이진화
- SCOPUS Author ID
- 이진화
- Issue Date
- 2017
- Journal Title
- International Journal of COPD
- ISSN
- 1176-9106
- Citation
- International Journal of COPD vol. 12, pp. 1135 - 1144
- Keywords
- Asthma; Cluster; COPD; Health care utilization; Overlap; Phenotype
- Publisher
- Dove Medical Press Ltd.
- Indexed
- SCOPUS
- Document Type
- Article
- Abstract
- Purpose: The purpose of this study was to identify subtypes in patients with mild-to-moderate airflow limitation and to appreciate their clinical and socioeconomic implications. Methods: Subjects who were aged ≥20 years and had forced expiratory volume in 1 second (FEV1) ≥60% predicted and FEV1/forced vital capacity <0.7 were selected from the fourth Korea National Health and Nutrition Examination Survey (KNHANES) in 2007–2012. The data were merged to the National Health Insurance reimbursement database during the same period. k-Means clustering was performed to explore subtypes. For clustering analysis, six key input variables – age, body mass index (BMI), FEV1% predicted, the presence or absence of self-reported wheezing, smoking status, and pack-years of smoking – were selected. Results: Among a total of 2,140 subjects, five groups were identified through k-means clustering, namely putative “near-normal (n=232),” “asthmatic (n=392),” “chronic obstructive pulmonary disease (COPD) (n=37),” “asthmatic-overlap (n=893),” and “COPD-overlap (n=586)” subtypes. Near-normal group showed the oldest mean age (72±7 years) and highest FEV1 (102%±8% predicted), and asthmatic group was the youngest (46±9 years). COPD and COPD-overlap groups were male predominant and all current or ex-smokers. While asthmatic group had the lowest prescription rate despite the highest proportion of self-reported wheezing, COPD, asthmatic-overlap, and COPD-overlap groups showed high prescription rate of respiratory medicine. Although COPD group formed only 1.7% of total subjects, they showed the highest mean medical cost and health care utilization, comprising 5.3% of the total medical cost. When calculating a ratio of total medical expense to household income, the mean ratio was highest in the COPD group. Conclusion: Clinical and epidemiological heterogeneities of subjects with mild-to-moderate airflow limitation and a different level of health care utilization by each subtype are shown. Identification of a subtype with high health care demand could be a priority for effective utilization of limited resources. © 2017 Lee et al.
- DOI
- 10.2147/COPD.S130140
- Appears in Collections:
- 의과대학 > 의학과 > Journal papers
- Files in This Item:
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