Acute Care Use by Patients With COPD Affected by Income Level, Stress, Study Says

Published on: 

Compared with patients with low stress, patients with chronic obstructive pulmonary disease (COPD) and high stress had doubled odds of using acute care services, a new study found.

Patients with chronic obstructive pulmonary disease (COPD) with high stress and low monthly income may use more acute care, according to a paper published in the Journal of the COPD Foundation.

Investigators from the University of Alabama Birmingham conducted a survey of patients with COPD in order to determine the association between low income and high stress levels and acute care use in these individuals. The study authors also hypothesized that there was an association between increased levels of perceived stress and higher frequency of acute care use, and that those with high stress are more likely to be affected by the disadvantages of social determinants of health (SDOH), such as income, education, social support, transportation, access to healthcare, housing stability, and food security.

The 126 participants included in the analysis received $25 in compensation for completing the survey. They were included in the study if they had a clinical diagnosis of COPD and complete data regarding income and stress levels. The investigators classified the patients into 2 groups: high and low stress. Low-income individuals were defined as those with a reported <$2000 monthly total family income, and high-income individuals reported higher than that number.

Then, the investigators classified the patients into 4 groups based on income and stress levels: (1) high-income plus low stress, (2) low-income plus low stress, (3) high-income plus high stress, and (4) low-income plus high stress.


The high stress group was more likely to be less than 65 years old and female, the study authors reported; no differences in race, current smoking status, years of smoking, body mass index, dyspnea, or lung function were observed between the stress groups. Levels of anxiety and depression were also no different between the high and low stress groups, the authors said.

The group with higher stress more frequently rated their health as “poor” and experienced lower quality of life. This group also had a higher incidence of overall use of acute care services in the prior 2 years, the investigators found. The high stress participants had lower monthly income, including difficulty affording mental, dental, and specialist care, as well as higher levels of neighborhood disorder and illicit drug use, the study authors added.

The final group—those with low income and high stress—were more often young, active smokers with a poor quality of life, the study authors wrote. While both high stress groups had high COPD acute care use frequency, those with lower income had the highest number of individuals who utilized acute care services compared to the other cohorts.

This group was the least likely to own a care, have health insurance, or have education beyond high school. They were the most likely to experience food insecurity, perceive discrimination, have a history of drug use, and live in neighborhoods with high levels of disorder, the study authors continued.

While the high stress, high income group was more likely to be married or living together, the high stress, low income group reported lower scores of social support. The low income, high stress group was unable to afford prescription medicine and mental, dental, specialist, and follow up care compared to the group with low income and low stress, the investigators added.

“We found that compared to low stress, high stress more than doubled the odds of using acute care services, with 4-fold increased odds in those with both low income and high stress,” the study authors wrote. “Our study also provided a comprehensive description of the SDH characteristics seen in COPD individuals, data which is not frequently found in existing literature… The results from our study highlight a relationship between stress and acute care use in individuals with COPD, particularly those who are vulnerable and may lack the tangible and emotional resources needed to cope with stressful events.”


Parekh TM, Cherrington AL, Bhatia SM, et al. The association of low income and high stress with acute care use in COPD patients. Chronic Obstr Pulm Dis. 2020;7(2):107-117. doi: 10.15326/jcopdf.7.2.2019.0165.