Acute Exacerbations of COPD in the United States: Inpatient Burden and Predictors of Costs and Mortality

Abstract

Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are a leading cause of hospitalizations in the United States and the major cost driver of COPD. This study determined the national inpatient burden of AECOPD and assessed the association of co-morbidities and hospital characteristics with inpatient costs and mortality. Discharge records from the Agency for Healthcare Research and Quality (AHRQ) Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample for 2006 was utilized. Outcomes of costs and mortality were assessed for AECOPD hospitalizations in cases ≥40 years of age. Multivariate regression analyses using a generalized linear model framework were conducted to determine predictors of inpatient costs and mortality controlling for patient demographics, primary payer, co-morbidity index, length of stay, hospital region, mechanical ventilation, and admission period. Overall, 1,254,703 hospitalizations for AECOPD were observed with mean costs of $9545(±12,700) and total costs of $11.9 billion. In-hospital mortality was 4.3% (N = 53,748). Discharges averaged 70.6 (±11.9) years of age. The majority were female (52.8%) and of white race (83.6% of reported race). Several co-morbidities were significantly associated with both costs and mortality (p < 0.001): acute myocardial infarction; congestive heart failure; cerebrovascular disease; lung cancer; cardiac arrhythmias; pulmonary circulation disorders; and weight loss. Significantly higher costs (p < 0.001) were associated with large and urban hospitals. The importance of co-morbidities in AECOPD is indicated in their association with prognosis and inpatient costs. Future research should determine if better management of these conditions can favorably impact the COPD disease burden.

A Real-World Study of 30-Day Exacerbation Outcomes in Chronic Obstructive Pulmonary Disease (COPD) Patients Managed with Aerobika OPEP

“…During an exacerbation, airways are compromised by inflammation and mucus build up, which, in turn, increase lung hyperinflation [8]. Many COPD patients experience two to three exacerbations every year, suggesting a continued need to manage their disease [9][10][11].…”

Home or community-based pulmonary rehabilitation for individuals with chronic obstructive pulmonary disease: a systematic review and meta-analysis

“…The consequences can be systemic 1,2 . COPD is a leading cause of death worldwide -including Europe 3,4 , the United States 5 , and Brazil 6 . COPD was the sixth leading cause of death in the world in 1990 and fourth in 2000, and is estimated to reach third place by 2020 3 .…”

Costs of the Patients Hospitalized with Acute Exacerbations of Chronic Obstructive Pulmonary Disease in a University Hospital

“…In the analysis of Perera et al (14), which was conducted within the scope of the Agency for Healthcare Research and Quality (AHRQ) Healthcare Cost and Utilization Project (HCUP) Nationwide in the USA, a total of 1,254,703 hospitalized cases of COPD exacerbation were evaluated. In this study, the mean total cost was found to be Compared with other countries, the fees paid by the government for hospitalization and treatment are lower in Turkey.…”