Burden of Pertussis in COPD: A Retrospective Database Study in England

Abstract

Chronic obstructive pulmonary disease (COPD) may increase the risk and severity of pertussis infection. Health care resource utilization (HCRU) and direct medical costs (DMC) of treating pertussis among patients with COPD are unknown. Reported incidence of pertussis among individuals aged ! 50 years with COPD was assessed in Clinical Practice Research Datalink and Hospital Episode Statistics databases during 2009-2018 using a retrospective cohort design. HCRU and DMC from the National Health Service perspective were compared between patients with COPD and pertussis and propensity score-matched patients with COPD without pertussis. Seventy-eight new pertussis events were identified among 387 086 patients with COPD aged ! 50 years (incidence rate: 4.73; 95% confidence interval 3.74-5.91 per 100 000 person-years). HCRU and DMC were assessed among 67 patients with COPD and pertussis and 267 matched controls. During the month before the pertussis diagnosis, the rates of general practitioner (GP)/nurse visits (4289 vs. 1774 per 100 patient-years) and accident and emergency visits (182 vs. 18 per 100 patient-years) were higher in the pertussis cohort; GP/nurse visits (2935 vs. 1705 per 100 patient-years) were also higher during the following 2 months (all p < 0.001). During the month before the pertussis diagnosis, annualized per-patient total DMC were £2012 higher in the pertussis cohort (£3729 vs. £1717; p < 0.001); during the following 2 months, they were £2407 higher (£5498 vs. £3091; p < 0.001). In conclusion, a pertussis episode among individuals with COPD resulted in significant increases in HCRU and DMC around the pertussis event.

Improving vaccination rates in older adults and at-risk groups: focus on pertussis

“…Other complications are less frequent and include seizures and encephalopathy (cerebral hypoxia related to asphyxia), subarachnoid and intraventricular haemorrhages, and tetanic seizures [ 45 ]. Individuals with underlying conditions, such as asthma, chronic obstructive pulmonary disease (COPD), and obesity are at an even higher risk to develop a severe form of the disease [ 46 – 48 ], and recent studies suggest that pertussis incidence in COPD populations may be grossly underestimated [ 49 , 50 ]. Pertussis has been associated with an increase in healthcare resource use in patients with COPD and asthma, increasing the overall economic burden, exacerbation, and hospitalisation rate related to the disease [ 51 – 53 ].…”

Burden of Pertussis in Individuals with a Diagnosis of Asthma: A Retrospective Database Study in England

“…5 The overall incidence of laboratory confirmed pertussis cases across all age groups in England in 2019 was 7 per 100,000 population 6 (approximately 5 notifications per 100,000 among those aged ≥45 years), 5,7 but seroprevalence studies from Europe indicate that the true rate of pertussis infection could be hundreds or even thousands of times higher than the reported incidence. [8][9][10] Data from patients with chronic obstructive pulmonary disease (COPD) in England also support this under-recognition, as the rate of diagnosed pertussis was approximately 5 per 100,000 in 2013, 11 but a seroprevalence study in the same year indicated that 5.8% of COPD patients had antibody levels indicative of exposure to B. pertussis in the past year. 12 Pertussis is particularly under-recognized or misdiagnosed in adults, 13,14 possibly because health care providers often view pertussis as a childhood disease, 15 instead suspecting acute bronchitis or simply "cough", 16 also because adults can be asymptomatic 17 or present with mild or atypical symptoms.…”

“…3 Patients with asthma or COPD have also been reported to incur higher health care resource utilization (HCRU) and direct medical costs (DMC) 21 than those with pertussis alone. Among adults with COPD, a diagnosis of pertussis has been associated with higher HCRU and DMC, 11 but the additional burden of asthma and pertussis compared to asthma alone has not yet been studied.…”

Manifesto on the Value of Adult Immunization: “We Know, We Intend, We Advocate”

“…For example, seasonal influenza infection in people with pre-existing circulatory or respiratory disease may result in their hospitalization or death [61]. Adults aged more than 50 years and who have HZ are at increased risk of asthma, heart disease, stroke, and transient ischemic attack [12,13,[62][63][64], while pertussis infection is likely to increase the severity of symptoms in patients with pre-existing asthma or COPD [14][15][16].…”

“…Chronic diseases in older adults are more difficult to treat in the presence of infectious diseases. Infectious diseases may induce cardiovascular complications, increase the risk of heart disease, and worsen asthma or chronic obstructive pulmonary disease (COPD) symptoms [11][12][13][14][15][16].…”