Age <60 years, female gender, severe dyspnea, and high deprivation were associated with significantly lower odds of enrolling and completing pulmonary rehabilitation (e.g., age <60 enrolment OR 0.46).
Observational (n=88,446)
Yes
Do determinants of health such as age, gender, ethnicity, and deprivation impact the enrolment and completion of pulmonary rehabilitation in individuals with COPD?
Significant health inequalities exist in the enrolment and completion of pulmonary rehabilitation for COPD patients, particularly affecting younger, female, more deprived, and more symptomatic individuals.
Odds Ratio: 0.46 (95% CI 0.42–0.51)
p-value: p=<0.01
Introduction 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. Methods 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. Results 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. Discussion 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.
Drover et al. (2026) conducted an observational in COPD (n=88,446). Determinants of health (age, gender, ethnicity, MRC grade, IMD quintile) vs. Reference demographic groups was evaluated on Enrolment and completion of pulmonary rehabilitation (OR 0.46, 95% CI 0.42-0.51, p=<0.01). Age <60 years, female gender, severe dyspnea, and high deprivation were associated with significantly lower odds of enrolling and completing pulmonary rehabilitation (e.g., age <60 enrolment OR 0.46).