Mortality, seasonal variation, and susceptibility to acute exacerbation of COPD in the pandemic year: a nationwide population study

Abstract

Background: Previous studies have suggested that the coronavirus disease 2019 (COVID-19) pandemic was associated with a decreased rate of acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Data on how the COVID-19 pandemic has influenced mortality, seasonality of, and susceptibility to AECOPD in the chronic obstructive pulmonary disease (COPD) population is scarce. Methods: We conducted a national population-based retrospective study using data from the Health Insurance Institute of Slovenia from 2015 to February 2021, with 2015–2019 as the reference. We extracted patient and healthcare data for AECOPD, dividing AECOPD into severe, resulting in hospitalisation, and moderate, requiring outpatient care. The national COPD population was generated based on dispensed prescriptions of inhalation therapies, and moderate AECOPD events were analysed based on dispensed AECOPD medications. We extracted data on all-cause and non-COVID mortality. Results: The numbers of severe and moderate AECOPD were reduced by 48% and 34%, respectively, in 2020. In the pandemic year, the seasonality of AECOPD was reversed, with a 1.5-fold higher number of severe AECOPD in summer compared to winter. The proportion of frequent exacerbators (⩾2 AECOPD hospitalisations per year) was reduced by 9% in 2020, with a 30% reduction in repeated severe AECOPD in frequent exacerbators and a 34% reduction in persistent frequent exacerbators (⩾2 AECOPD hospitalisations per year for 2 consecutive years) from 2019. The risk of two or more moderate AECOPD decreased by 43% in 2020. In the multivariate model, pandemic year follow-up was the only independent factor associated with a decreased risk for severe AECOPD (hazard ratio [HR]: 0.71; 95% confidence interval [CI]: 0.61–0.84; p < 0.0001). In 2020, non-COVID mortality decreased (−15%) and no excessive mortality was observed in the COPD population. Conclusion: In the pandemic year, we found decreased susceptibility to AECOPD across severity spectrum of COPD, reversed seasonal distribution of severe AECOPD and decreased non-COVID mortality in the COPD population.

Hospital admissions and mortality for acute exacerbations of COPD during the COVID-19 pandemic: a nationwide study in France

“…A reduction in hospitalizations for AECOPD during the first months of the pandemic has been documented in the literature, with estimates ranging from -42% to -48% among nationwide studies. 6–8,15,17 In this study, we show that this phenomenon persisted far beyond the first pandemic wave, with a global decline of -35% hospital admissions when considering the whole 2020-2021 pandemic years, and nearly 60,000 fewer stays than expected in the absence of a pandemic. In contrast, hospitalizations for causes other than COVID-19 reduced by only 13% in France in 2020 compared to 2019, 23 indicating that the decline was steeper for AECOPD-related hospitalizations.…”

“…However, this assumption is not supported by nationwide studies from Denmark and Slovenia, where all-cause mortality was reported to decrease in COPD patients, regardless of severity. 7,8 Our second major finding is a 24% increase in the proportion of in-hospital deaths for AECOPD stays during the pandemic, with nearly 2,000 estimated excess deaths. There could be several reasons for this observation.…”

“…However, this assumption is not supported by nationwide studies from Denmark and Slovenia, where all-cause mortality was reported to decrease in COPD patients, regardless of severity. 7,8…”

“…15 Furthermore, findings on inhospital mortality trends for COPD patients during the pandemic are inconsistent. Two studies found an increased mortality in 2020 compared to pre-pandemic years, of respectively +53% and +130% but both were based on small numbers, 8,16 while others did not find a significant difference. 11,12,14 To date, time trends in in-hospital mortality have not been analysed with largescale and exhaustive data.…”

“…3,4 A substantial decrease in the number of hospital admissions for acute exacerbation of COPD (AECOPD) during the first months of the COVID-19 pandemic has been reported in several countries, [5][6][7][8][9][10][11][12][13][14][15][16][17] ranging from -42% to -48% among nationwide studies. [6][7][8]15,17 This observation raises two critical concerns in terms of generalizability. First, whether this downturn pattern persisted over the entire pandemic period remains unknown, as most studies covered the first wave only, 6,7,[12][13][14][15][16] and no study spanning beyond February 2021 has yet been published.…”