Predicting Chronic Obstructive Pulmonary Disease Hospitalizations Based on Concurrent Influenza Activity

Abstract

Although influenza has been associated with chronic obstructive pulmonary disease (COPD) exacerbations, it is not clear the extent to which this association affects healthcare use in the United States. The first goal of this project was to determine to what extent the incidence of COPD hospitalizations is associated with seasonal influenza. Second, as a natural experiment, we used influenza activity to help predict COPD admissions during the 2009 H1N1 influenza pandemic. To do this, we identified all hospitalizations between 1998 and 2010 in the Nationwide Inpatient Sample from the Healthcare Cost and Utilization Project (HCUP) during which a primary diagnosis of COPD was recorded. Separately, we identified all hospitalizations during which a diagnosis of influenza was recorded. We formulated time series regression models to investigate the association of monthly COPD admissions with influenza incidence. Finally, we applied these models, fit using 1998–2008 data, to forecast monthly COPD admissions during the 2009 pandemic. Based on time series regression models, a strong, significant association exists between concurrent influenza activity and incidence of COPD hospitalizations (p-value<0.0001). The association is especially strong among older patients requiring mechanical ventilation. Use of influenza data to predict COPD admissions during the 2009 H1N1 pandemic reduced the mean-squared prediction error by 29.9%. We conclude that influenza activity is significantly associated with COPD hospitalizations in the United States and influenza activity can be exploited to more accurately forecast COPD admissions. Our results suggest that improvements in influenza surveillance, prevention, and treatment may decrease hospitalizations of patients diagnosed with COPD.

Hypercapnia Suppresses Macrophage Antiviral Activity and Increases Mortality of Influenza A Infection via Akt1

“…Importantly, COPD and the other clinical scenarios associated with hypercapnia all carry a high risk of pulmonary infection, including community-acquired pneumonia (8). Also, bacterial and viral pulmonary infections, especially influenza (9)(10)(11), are a principal cause of acute COPD exacerbations (12), and are linked to increased need for hospitalization and to mortality (13).…”

“…Influenza viruses are the second most commonly identified cause of community-acquired pneumonia requiring hospitalization among adults in the U.S (27). Influenza infections are also among the most common causes of hospitalization for acute exacerbations of COPD (9)(10)(11)28), which in total account for 1.9% of all hospitalizations in the U.S. and approximately 20 % of hospitalizations among individuals >65 years of age (29). The high morbidity and mortality of influenza in those with underlying chronic lung disease suggest that hypercapnia may contribute to poor clinical outcomes in such individuals.…”

Surfactant protein D, a clinical biomarker for chronic obstructive pulmonary disease with excellent discriminant values

“…Chronic obstructive pulmonary disease (COPD) is ranked as the fourth leading cause of mortality worldwide ( 1 ). A diagnosis of COPD is considered in any patient who has dyspnea, chronic cough or sputum production and a history of exposure to risk factors, but requires confirmation by spirometry ( 1 ).…”

“…Chronic obstructive pulmonary disease (COPD) is ranked as the fourth leading cause of mortality worldwide ( 1 ). A diagnosis of COPD is considered in any patient who has dyspnea, chronic cough or sputum production and a history of exposure to risk factors, but requires confirmation by spirometry ( 1 ). This technique is, however, difficult for the patient, not always available, requires a certain expertise for its interpretation and is poorly correlated with disease severity ( 2 , 3 ).…”

Structural time series clustering, modeling, and forecasting in the state-space framework

“…acute myocardial infarction (AMI), asthma, congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), influenza, and pneumonia. Biological evidence exists to support our findings (Thompson et al, 2004;Foster et al, 2013;Gerke et al 2013 andWeinberger et al, 2015). In the next subsection, we discuss how to facilitate forecasting using model averaging for settings that involve multiple related series.…”