predictors of non-conventional laparoscopic approach to leiomyoma hysterectomy. Our findings suggest that there is a differential access to LH procedures among the US population which may be, in part, a result of racial and socioeconomic differences and centralization of laparoscopy services in urban areas.

were identified from the Truven MarketScan database. We measured demographic and clinical characteristics in the 12-month period prior to first date of use, the index date. Adherence was measured using prescription days covered (PDC) $ 80% threshold over a 6-month period. We calculated persistence as the proportion of patients that did not discontinue roflumilast, defined as a gap of .30 days. Results: A total of 9919 patients were included with a mean age of 67.7 years (610.1) and 4972 (50.1%) were female. Inhaled corticosteroids (ICS) and long-acting beta agonists (LABA), single inhaler use or in combination, were frequently used, 7300 (73.6%) and 7073 (71.3%) respectively, in the baseline period. We also captured multiple COPD medication use prior to the index date. Accordingly, LABA and ICS 6903 (69.6%) were commonly prescribed followed by long acting muscarinic antagonists (LAMA) and ICS (5112, 51.5%). The overall PDC over a 6-month period was 69% with only 3104 (48.8%) patients being adherent (PDC$ 80%). Over the same 6-month period, only 2581 (26.0%) were persistent. We also measured PDC over 3-month (81%) and 12-month (56%). In addition, persistence to roflumilast was 4899 (49.4%) and 1196 (12.1%) over a 3-and 12month period respectively. Conclusions: A substantial number of adult patients with COPD have sub-optimal adherence and persistence to roflumilast. Reasons for low adherence or discontinuation such as prevalence of treatment-related adverse effects deserve further investigation.