Disease Burden of Patients with Asthma/COPD Overlap in a US Claims Database: Impact of ICD-9 Coding-based Definitions

Wurst, Keele; Laurent, Samantha St.; Hinds, David; Davis, Kourtney J.

doi:10.1080/15412555.2016.1257598

Cited by 23 publications

(18 citation statements)

References 17 publications

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“…However, the lower costs observed in the confirmed ACO cohort differed from prior studies that showed ACO patients with higher resource utilization and costs [18,33-35]. This suggests a striking method effect upon results across studies.…”

Section: Discussioncontrasting

confidence: 65%

Overlap of Asthma and Chronic Obstructive Pulmonary Disease in Patients in the United States: Analysis of Prevalence, Features, and Subtypes

Turner¹,

DePietro²,

Ding³

2018

JMIR Public Health Surveill

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BackgroundAlthough asthma and chronic obstructive pulmonary disease (COPD) are clinically distinct diseases, they represent biologically diverse and overlapping clinical entities and it has been observed that they often co-occur. Some research and theorizing suggest there is a common comorbid condition termed asthma-chronic obstructive pulmonary disease overlap (ACO). However, the existence of ACO is controversial.ObjectiveThe objective of this study is to describe patient characteristics and estimate prevalence, health care utilization, and costs of ACO using claims-based diagnoses confirmed with medical record information.MethodsEligible patients were commercial US health plan enrollees; ≥40 years; had asthma, COPD, or ACO; ≥3 prescription fills for asthma/COPD medications; and ≥2 spirometry tests. Records for a random sample of 5000 patients with ACO were reviewed to validate claims-based diagnoses.ResultsThe estimated ACO prevalence was 6% (estimated 10,250/183,521) among 183,521 full study patients. In the claims-based cohorts, the comorbidity burden for ACO was greater versus asthma but similar to COPD cohorts. Medication utilization was higher in ACO versus asthma and COPD. Mean total health care costs were significantly higher for ACO versus asthma but similar to COPD. In confirmed diagnoses cohorts, mean total health care costs (medical plus pharmacy) were lower for ACO versus COPD but similar to asthma (US $20,035; P=.56). Among confirmed cases, where there was medical record evidence, smoking history was higher in ACO (300/343, 87.5%) versus asthma cohorts (100/181, 55.2%) but similar to COPD (68/84, 81%).ConclusionsACO had more comorbidities, medication utilization, and costs than patients with asthma or COPD but differences were not seen after confirmation with medical records.

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Section: Discussioncontrasting

confidence: 65%

Overlap of Asthma and Chronic Obstructive Pulmonary Disease in Patients in the United States: Analysis of Prevalence, Features, and Subtypes

Turner¹,

DePietro²,

Ding³

2018

JMIR Public Health Surveill

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“…There were 15,762 patients aged ≥65 years who either had at least 2 outpatient visits or 1 inpatient admission for COPD as a primary diagnosis (ICD-9-CM codes: 491.xx, 492.xx, 496.xx) [5,6,28,29] identified during the period from January 1, 2005, to December 31, 2011. The index date was set as the earliest date for patients who had a record during this period.…”

Section: Study Subjectsmentioning

confidence: 99%

“…Due to the relationship between socioeconomic status (SES) and health care outcomes [38,39], insurance premiums were used as a proxy for SES because the NHI claims data set does not provide patients' educational levels or household incomes. In addition, health status and disease severity may affect the measurement of health outcomes [6,9,16,39]; therefore, any history of hypertension (ICD-9-CM codes 401.xx-405.xx), and diabetes (ICD-9-CM codes 250.xx) [4,6,9], whether a patient had ED visits for COPD or asthma and whether a patient was hospitalized for COPD or asthma were included in the previous year of the index date. The Charlson comorbidity index (CCI) [4,5,7,40] that was calculated for each patient according to outpatient or inpatient care by using the Quan adaptation of the Elixhauser comorbidities [41] and the number of outpatient visits for COPD or asthma (3-12, 13-24, and ≥25 times) [16] was measured during the COC period.…”

Section: Covariatesmentioning

confidence: 99%

“…Studies of ACO reported the prevalence ranges from 0.9% to 11.1% among general population around the world [3]. The disease burden and healthcare utilization such as emergency department (ED) visits and hospital admissions for patients with ACO has been found to be higher than those with asthma or COPD alone [4][5][6][7][8][9]. While the importance of caring for patients with ACO has become a critical issue, there is limited information regarding treatment in ACO patients to reduce the resulting healthcare utilization.…”

Section: Introductionmentioning

confidence: 99%

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Association between continuity of care and emergency department visits and hospitalization in senior adults with asthma-COPD overlap

Kao

Tseng

et al. 2019

Health Policy

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a b s t r a c tObjective: To investigate associations between continuity of care (COC) and emergency department (ED) visits and hospitalization for chronic obstructive pulmonary disease (COPD) or asthma among elderly adults with asthma-COPD overlap (ACO). Methods: A retrospective cohort study was performed using the Taiwan National Health Insurance research database. A total of 1141 ACO patients aged ≥65 years during 2005-2011 were observed and followed for 2 years. The Bice and Boxerman COC index (COCI) was used to evaluate COC by considering ambulatory care visits duo to COPD or asthma in the first year; ED visits and hospitalization for COPD or asthma were identified in the subsequent year, respectively. The COCI was divided into three levels (COCI < 0.3= low, 0.3 ≤ COCI<1=medium, COCI = 1=high). The Cox model was used to estimate the hazard ratio (HR) for ED visits and hospital admissions due to COPD or asthma. Results: The average COCI was 0.55. 21.3% patients received outpatient care from a single physician. Compared to patients with high COC, those with low and medium COC had a higher risk of ED visits (aHR = 2.80 and 2.69, P < .01) and admissions (aHR = 1.80 and 1.72, P < .05). Conclusion: Increasing COC is beneficial for elderly patients with ACO in disease management. Policymakers could create effective pay-for-performance programs for the elderly ACO population to enhance COC and improve care outcomes.

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“…[18] However, the lower costs observed in the confirmed ACO cohort differed from prior studies that showed ACO patients with higher resource utilization and costs. [18,[32][33][34] This suggests a striking method effect upon results across studies. Costs are critical in public health activities, and they have important implications for all stakeholders.…”

Section: Comparisons With Prior Studiesmentioning

confidence: 99%

Overlap of Asthma and Chronic Obstructive Pulmonary Disease in Patients in the United States: Analysis of Prevalence, Features, and Subtypes (Preprint)

Turner¹,

DePietro²,

Ding³

2018

Preprint

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Disease Burden of Patients with Asthma/COPD Overlap in a US Claims Database: Impact of ICD-9 Coding-based Definitions

Cited by 23 publications

References 17 publications

Overlap of Asthma and Chronic Obstructive Pulmonary Disease in Patients in the United States: Analysis of Prevalence, Features, and Subtypes

Overlap of Asthma and Chronic Obstructive Pulmonary Disease in Patients in the United States: Analysis of Prevalence, Features, and Subtypes

Association between continuity of care and emergency department visits and hospitalization in senior adults with asthma-COPD overlap

Overlap of Asthma and Chronic Obstructive Pulmonary Disease in Patients in the United States: Analysis of Prevalence, Features, and Subtypes (Preprint)

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