Characteristics of US Medicare Beneficiaries with Chronic Cough vs. Non-Chronic Cough: 2011–2018
Abstract
:1. Introduction
2. Materials and Methods
2.1. Data Sources
2.2. Study Design and Cohort
2.3. Outcomes of Interest
2.4. Covariates
2.5. Statistical Analysis
2.6. Subgroup Analyses
3. Results
3.1. Trends in Annual Gabapentinoid Use from Repeated Cross-Sectional Analyses
3.2. GBTM Analysis: 2011–2018 Medicare Data
3.2.1. Characteristics of Patients with CC and Individuals without CC but with Any Respiratory Conditions Related to Cough
3.2.2. Gabapentinoid Utilization Trajectories
3.2.3. Characteristics of Patients with CC by Gabapentinoid Utilization Trajectories
3.2.4. Characteristics of Individuals without CC but with Any Respiratory Conditions Related to Cough by Gabapentinoid Utilization Trajectories
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Characteristic a | Pre-Index Period b | Post-index Period c | ||||
---|---|---|---|---|---|---|
CC Cohort | Non-CC Cohort | p-Value | CC Cohort | Non-CC Cohort | p-Value | |
N | 39,848 | 831,680 | 39,848 | 831,680 | ||
Demographics, % | ||||||
Age in years, mean (SD) | 71.9 (12.5) | 70.1 (12.7) | <0.001 | 71.9 (12.5) | 70.1 (12.7) | <0.001 |
Age ≥ 65 years | 82.5 | 81.7 | <0.001 | 82.5 | 81.7 | <0.001 |
Female | 69.0 | 62.4 | <0.001 | 69.0 | 62.4 | <0.001 |
Race/ethnicity | <0.001 | <0.001 | ||||
Hispanic | 8.0 | 6.7 | 8.0 | 6.7 | ||
Non-Hispanic White | 78.4 | 80.5 | 78.4 | 80.5 | ||
Non-Hispanic Black | 8.6 | 8.0 | 8.6 | 8.0 | ||
Others/multiple/unknown | 5.1 | 4.9 | 5.1 | 4.9 | ||
Disability | 28.1 | 25.9 | <0.001 | 28.1 | 25.9 | <0.001 |
LIS and dual Medicaid eligibility | <0.001 | <0.001 | ||||
No LIS or dual eligibility | 61.9 | 68.4 | 61.9 | 68.4 | ||
Only LIS or dual eligibility | 3.7 | 5.2 | 3.7 | 5.2 | ||
Both LIS and dual eligibility | 34.4 | 26.4 | 34.4 | 26.4 | ||
Residency in a metropolitan area | 84.2 | 81.3 | <0.001 | 84.2 | 81.3 | <0.001 |
Healthcare utilization factors, % | ||||||
Any hospitalization | 19.0 | 9.7 | <0.001 | 35.8 | 23.3 | <0.001 |
Emergency department visits | <0.001 | <0.001 | ||||
0 | 66.9 | 79.6 | 43.7 | 57.6 | ||
1 | 6.4 | 3.7 | 4.1 | 4.0 | ||
≥2 | 26.7 | 16.7 | 52.2 | 39.4 | ||
Outpatient visits | <0.001 | <0.001 | ||||
0 | 0.7 | 3.7 | 0.0 | 0.0 | ||
1 | 0.4 | 1.4 | 0.0 | 0.2 | ||
2–4 | 2.1 | 5.7 | 0.0 | 0.7 | ||
≥5 | 96.8 | 89.2 | 100.0 | 99.1 | ||
Comorbidity index, mean (SD) | ||||||
Elixhauser index d | 2.0 (1.9) | 1.4 (1.6) | <0.001 | 3.1 (2.4) | 2.1 (2.1) | <0.001 |
No. of encounters with respiratory conditions related to cough, mean (SD) | ||||||
No. visits with acute URTI | n/m | n/m | 2.3 (4.7) | 1.8 (3.4) | <0.001 | |
No. visits with bronchitis | n/m | n/m | 4.1 (8.6) | 1.6 (4.5) | <0.001 | |
No. visits with chronic URTD | n/m | n/m | 1.8 (5.7) | 0.7 (2.9) | <0.001 | |
No. visits with cough | n/m | n/m | 0.6 (3.1) | 0.1 (1.0) | <0.001 | |
No. visits with influenza | n/m | n/m | 0.6 (3.5) | 0.3 (2.6) | <0.001 | |
No. visits with pneumonia | n/m | n/m | 5.5 (14.0) | 2.1 (8.1) | <0.001 | |
No. visits with any respiratory conditions related to cough | n/m | n/m | 13.7 (18.7) | 6.2 (10.2) | <0.001 | |
Respiratory comorbidities, % | ||||||
Acute URTI | 22.2 | 0.0 | <0.001 | 45.0 | 52.6 | <0.001 |
Allergic rhinitis | 17.6 | 6.4 | <0.001 | 37.8 | 16.2 | <0.001 |
Asthma | 20.0 | 6.0 | <0.001 | 36.8 | 12.2 | <0.001 |
Bronchiectasis | 2.8 | 0.4 | <0.001 | 8.2 | 1.0 | <0.001 |
Bronchitis | 21.8 | 0.0 | <0.001 | 47.6 | 32.8 | <0.001 |
Chronic URTD | 9.8 | 0.0 | <0.001 | 26.2 | 15.0 | <0.001 |
COPD | 33.8 | 10.6 | <0.001 | 58.4 | 28.4 | <0.001 |
Cough | 28.8 | 0.0 | <0.001 | 100.0 | 47.2 | <0.001 |
Influenza | 1.0 | 0.0 | <0.001 | 6.4 | 4.6 | <0.001 |
Obstructive sleep apnea | 12.8 | 7.8 | <0.001 | 20.2 | 11.6 | <0.001 |
Pneumonia | 11.6 | 0.0 | <0.001 | 31.2 | 14.8 | <0.001 |
Pulmonary fibrosis | 3.6 | 0.8 | <0.001 | 10.0 | 2.4 | <0.001 |
UACS | 2.6 | 0.4 | <0.001 | 11.6 | 2.8 | <0.001 |
Non-respiratory comorbidities, % | ||||||
Anxiety disorders | 23.4 | 14.8 | <0.001 | 36.0 | 24.0 | <0.001 |
Atrial fibrillation | 15.0 | 10.2 | <0.001 | 20.8 | 14.6 | <0.001 |
Coronary artery disease | 29.4 | 21.0 | <0.001 | 40.0 | 29.8 | <0.001 |
GERD | 34.0 | 18.4 | <0.001 | 59.2 | 31.8 | <0.001 |
Heart failure | 16.0 | 7.6 | <0.001 | 26.4 | 14.2 | <0.001 |
Hypertension | 71.8 | 61.4 | <0.001 | 83.2 | 75.0 | <0.001 |
Mood disorders | 25.2 | 16.2 | <0.001 | 35.6 | 24.2 | <0.001 |
Musculoskeletal conditions | 70.6 | 57.0 | <0.001 | 84.8 | 74.0 | <0.001 |
Non-opioid substance use disorders | 5.8 | 4.6 | <0.001 | 12.2 | 10.6 | <0.001 |
Obesity | 18.8 | 13.8 | <0.001 | 30.0 | 23.2 | <0.001 |
Opioid use disorders | 2.2 | 1.4 | <0.001 | 3.6 | 2.4 | <0.001 |
Other immune disorders | 6.6 | 4.0 | <0.001 | 9.8 | 6.0 | <0.001 |
Peripheral vascular disease | 10.6 | 6.6 | <0.001 | 16.2 | 10.8 | <0.001 |
Sleep disturbance | 9.6 | 5.4 | <0.001 | 16.8 | 10.0 | <0.001 |
Stress incontinence | 4.4 | 2.6 | <0.001 | 7.2 | 4.4 | <0.001 |
Vomiting | 2.4 | 1.0 | <0.001 | 6.0 | 2.8 | <0.001 |
Procedures, % | ||||||
Allergy radioallergosorbent testing | 16.0 | 10.4 | <0.001 | 36.6 | 20.8 | <0.001 |
Barium swallow or upper GI imaging | 3.2 | 1.0 | <0.001 | 12.2 | 3.4 | <0.001 |
Chest CT/MRI/ultrasound | 18.6 | 9.0 | <0.001 | 50.8 | 23.0 | <0.001 |
Chest X-ray | 35.6 | 15.4 | <0.001 | 82.8 | 52.0 | <0.001 |
Complete blood count | 53.2 | 44.8 | <0.001 | 88.2 | 78.6 | <0.001 |
Esophageal endoscopy | 5.6 | 3.4 | <0.001 | 15.2 | 7.4 | <0.001 |
Laryngoscopy | 2.8 | 0.6 | <0.001 | 14.0 | 3.4 | <0.001 |
Nasal/sinus endoscopy | 10.0 | 4.6 | <0.001 | 23.4 | 12.0 | <0.001 |
Sinus X-ray/CT | 18.6 | 12.6 | <0.001 | 39.0 | 26.4 | <0.001 |
Spirometry | 18.6 | 5.2 | <0.001 | 58.8 | 19.8 | <0.001 |
Potential cough medication | ||||||
Gabapentinoids, % | 17.6 | 12.2 | <0.001 | 22.6 | 15.6 | <0.001 |
Cardiovascular medications (oral), % | ||||||
ACE inhibitors | 23.4 | 25.8 | <0.001 | 22.8 | 27.2 | <0.001 |
Respiratory medications (oral or inhaled), % | ||||||
H1 antihistamines | 6.6 | 3.4 | <0.001 | 10.6 | 5.8 | <0.001 |
ICS monotherapy | 3.6 | 1.0 | <0.001 | 8.8 | 2.0 | <0.001 |
ICS/LABA combination | 15.0 | 4.8 | <0.001 | 28.0 | 7.8 | <0.001 |
LAMA monotherapy | 5.8 | 1.8 | <0.001 | 9.6 | 2.6 | <0.001 |
Leukotriene modifiers | 13.8 | 4.0 | <0.001 | 25.6 | 6.8 | <0.001 |
Nasal antihistamines | 3.0 | 0.8 | <0.001 | 8.2 | 2.2 | <0.001 |
Nasal corticosteroids | 17.0 | 6.8 | <0.001 | 31.8 | 17.0 | <0.001 |
Nasal SAMA | 2.2 | 0.6 | <0.001 | 6.2 | 1.8 | <0.001 |
SABA singly inhaled | 20.6 | 6.4 | <0.001 | 40.8 | 18.6 | <0.001 |
SABA/SAMA combination | 3.4 | 0.8 | <0.001 | 7.6 | 1.8 | <0.001 |
Gastrointestinal (oral), % | ||||||
H2 blockers | 10.2 | 5.8 | <0.001 | 17.6 | 8.6 | <0.001 |
PPIs | 38.4 | 24.2 | <0.001 | 52.0 | 29.8 | <0.001 |
Miscellaneous (oral), % | ||||||
Corticosteroids | 28.4 | 10.2 | <0.001 | 55.0 | 30.8 | <0.001 |
Potential respiratory antibiotics | 62.0 | 32.6 | <0.001 | 87.0 | 78.0 | <0.001 |
Pain medications, psychotherapeutics, others (oral), % | ||||||
Antidepressants | 40.0 | 29.4 | <0.001 | 45.6 | 34.0 | <0.001 |
Antipsychotics | 9.6 | 7.0 | <0.001 | 11.4 | 8.4 | <0.001 |
Benzodiazepines | 23.2 | 16.4 | <0.001 | 28.0 | 20.2 | <0.001 |
Muscle relaxants | 10.2 | 7.4 | <0.001 | 15.0 | 11.2 | <0.001 |
Non-benzodiazepine hypnotics | 6.2 | 4.8 | <0.001 | 7.6 | 5.8 | <0.001 |
Opioid analgesics | 33.8 | 26.6 | <0.001 | 44.4 | 36.2 | <0.001 |
Other anxiolytics | 2.4 | 1.6 | <0.001 | 3.4 | 2.2 | <0.001 |
Other neuromodulators | 18.6 | 12.8 | <0.001 | 21.8 | 15.4 | <0.001 |
Specialist visits, % | ||||||
≥1 visit to allergist | n/m | n/m | 6.2 | 1.2 | <0.001 | |
≥1 visit to gastroenterologist | n/m | n/m | 1.3 | 0.8 | <0.001 | |
≥1 visit to otolaryngologist/head and neck surgeon | n/m | n/m | 15.5 | 5.9 | <0.001 | |
≥1 visit to pulmonologist | n/m | n/m | 15.4 | 2.7 | <0.001 | |
≥1 visit to urologist | n/m | n/m | 8.7 | 6.9 | <0.001 | |
Visited any specialists specified above | n/m | n/m | 37.1 | 15.9 | <0.001 | |
Visited ≥ 2 different specialists specified above | n/m | n/m | 30.5 | 11.8 | <0.001 | |
Visited ≥ 3 different specialists specified above | n/m | n/m | 25.8 | 9.2 | <0.001 | |
All missing specialty information | n/m | n/m | 0.1 | 0.2 | <0.001 |
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Yang, S.; Huang, S.; Hincapie-Castillo, J.M.; Ke, X.; Ding, H.; Sher, M.R.; Jones, B.; Wilson, D.L.; Lo-Ciganic, W.-H. Characteristics of US Medicare Beneficiaries with Chronic Cough vs. Non-Chronic Cough: 2011–2018. J. Clin. Med. 2024, 13, 4549. https://doi.org/10.3390/jcm13154549
Yang S, Huang S, Hincapie-Castillo JM, Ke X, Ding H, Sher MR, Jones B, Wilson DL, Lo-Ciganic W-H. Characteristics of US Medicare Beneficiaries with Chronic Cough vs. Non-Chronic Cough: 2011–2018. Journal of Clinical Medicine. 2024; 13(15):4549. https://doi.org/10.3390/jcm13154549
Chicago/Turabian StyleYang, Seonkyeong, Shu Huang, Juan M. Hincapie-Castillo, Xuehua Ke, Helen Ding, Mandel R. Sher, Bobby Jones, Debbie L. Wilson, and Wei-Hsuan Lo-Ciganic. 2024. "Characteristics of US Medicare Beneficiaries with Chronic Cough vs. Non-Chronic Cough: 2011–2018" Journal of Clinical Medicine 13, no. 15: 4549. https://doi.org/10.3390/jcm13154549
APA StyleYang, S., Huang, S., Hincapie-Castillo, J. M., Ke, X., Ding, H., Sher, M. R., Jones, B., Wilson, D. L., & Lo-Ciganic, W.-H. (2024). Characteristics of US Medicare Beneficiaries with Chronic Cough vs. Non-Chronic Cough: 2011–2018. Journal of Clinical Medicine, 13(15), 4549. https://doi.org/10.3390/jcm13154549