Trends in Outcomes, Financial Burden, and Mortality for Acute Exacerbation of Chronic Obstructive Pulmonary Disease (COPD) in the United States from 2002 to 2010

Abstract

Chronic obstructive pulmonary disease (COPD) is the cause of substantial economic and social burden. We evaluated the temporal trends of hospitalizations from acute exacerbation of COPD and determine its outcome and financial impact using the National Inpatient Sample (NIS) databases (2002 to 2010). Individuals with age ≥ 18 years were included. Subjects who were hospitalized with primary diagnosis of COPD exacerbation and those who were admitted for other causes; but had underlying acute exacerbation of COPD (secondary diagnosis) were captured by ICD-9 codes. The hospital outcomes and length of stay were determined. Multivariate logistic regression was used to identify independent predictors of inpatient mortality. Overall acute exacerbation of COPD related hospitalizations accounted for nearly 3.31% of all hospitalizations in year 2002. This did not change significantly to year 2010 (3.43%, p=0.608). However, there was an increase in hospitalization with secondary diagnosis of COPD. Elderly white patients accounted for most of the hospitalizations. Medicare was the primary payer source for most of the hospitalizations (73%–75%). There was a significant decrease in inpatient mortality from 4.8% in 2002 to 3.9% in 2010 (slope −0.096, p<.001). Similarly, there was significant decrease in average length of stay from 6.4 days in 2002 to 6.0 days in 2010 (slope −0.042, p<.001). Despite this the hospitalization cost was increased substantially from $22,187 in 2002 to $38,455 in 2010. However, financial burden has increased over the years.

Nationwide Trends in Inpatient Admissions of Pulmonary Hypertension in the United States from 2000 to 2013

“…There was a trend towards admission of patients greater than 65 years of age that is in line with all recent studies that found a shift in diagnosis of PH to an older age [13,[18][19][20]. Most patients continued to be women in both 2000 and 2013.…”

Rural‐Urban Differences in In‐Hospital Mortality Among Admissions for End‐Stage Liver Disease in the United States

“…Patients with end‐stage liver disease (ESLD) are often critically ill and require hospital admission for the management of complications. Consistent with a general trend of improvement in outcomes across other common chronic conditions, there has been a substantial reduction of in‐hospital mortality rates among patients with cirrhosis over the past decade . This trend has been attributed to improved medical care aimed at prolonging life among patients with cirrhosis and increased attention to health care delivery, including quality improvement initiatives …”

“…Admitted patients were classified on the basis of International Classification of Diseases, Ninth Revision (ICD-9) diagnosis codes and put into 3 groups: cirrhosis (571. 2 This algorithm has been previously shown to have a high positive predictive value for identifying ESLD patients. (12) Admissions were included if they were from adult patients (>18 years of age) who had an ESLD-related admission between January 1, 2012, and December 31, 2014.…”

Expertentreffen COPD: Exazerbation der COPD

“…Hinsichtlich erneuter Hospitalisation, der Krankenhausverweildauer und der Mortalität hatte die rezentere Kohorte unter der neueren Therapie zwar signifikant bessere Ergebnisse. Die quantitativen Unterschiede waren jedoch gering, und bei der Mortalität beobachtete man eine Reduktion von 4,8 % im Jahr 2002 auf 3,9 % im Jahr 2010 [41].…”