Long-Term Mortality and Medical Burden of Patients with Chronic Obstructive Pulmonary Disease with and without Subsequent Stroke Episodes

Abstract

Background: We used the Taiwan National Health Insurance Research Database (NHIRD) to determine the differences in mortality and medical burden between patients with chronic obstructive pulmonary disease (COPD) with and without stroke. Methods: We enrolled participants aged ≥20 years and defined four subgroups in this study, namely patients with COPD (International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9 CM): 491, 492, 494, and 496), patients with COPD with stroke (ICD-9 CM: 430–438), with COPD without stroke, and comparison subgroups. We calculated the hazard ratios and 95% CIs for all-cause mortality risk, average duration of hospitalization, and frequency of medical visits in these subgroups after adjustments were made for age, sex, and comorbidities. All participants were followed until the date of death, the date they were censored, the date they withdrew from the NHIRD, or 31 December, 2013. Results: In total, 9.70% (men vs. women, 11.19% vs. 8.28%) of patients with COPD developed subsequent stroke during the 14 year follow-up. After a stroke, the risk of mortality exhibited a 2.66- to 5.05-fold increase, especially in the younger ones. COPD with stroke was also a leading factor in the increase in the average number of hospitalization days and frequency of medical visits. Conclusion: The mortality risk of patients with COPD is considerably increased by stroke independent of the other effects of COPD. Moreover, the average number of hospitalization days and frequency of medical visits dramatically increased in patients with COPD after stroke.

Propensity Score Analysis of the Association between Chronic Obstructive Lung Disease and Stroke Outcome: Thailand’s National Database

“…Our finding that COPD is positively associated with increased risk of in-hospital and long-term mortality is consistent with those of some previous studies [19, 20]. However, one retrospective study [10] found that COPD was not significantly associated with stroke severity at hospital admission nor with short-term outcome in stroke patients but only with long-term mortality during follow-up.…”

Sex Differences in the Incidence and Outcomes of COPD Patients Hospitalized with Ischemic Stroke in Spain: A Population-Based Observational Study

“…Similar results have been described by other authors. 25 Several factors may explain the increased mortality risk among patients with COPD. They include comorbid conditions that can be associated with increased mortality, 26 increased risk of dysphagia, that may predispose to the development of aspiration pneumonia in these patients, 27 gas exchange disturbances (hypoxemia and hypercapnia) and inflammation and oxidative stress during exacerbations.…”

Increased Medical Visits and Mortality among Adults with Cardiovascular Diseases in Severely Affected Areas after Typhoon Morakot

“…However, our study also suggested that affected populations with more co-morbidities (i.e., liver cirrhosis, CKD, COPD, asthma and neoplasms other than cardiovascular disease) have higher all-cause mortality hazards. The increased all-cause mortality occurred when patients with multimorbidity and pre-existing cardiovascular diseases such as stroke and ischemic heart diseases had increased risk of complications from either underlying diseases or comorbidities [ 32 , 33 , 34 , 35 , 36 , 37 ].…”