title: Population-based burden of COPD-related visits in the ED: return ED visits, hospital admissions, and comorbidity risks.
abstract: BACKGROUND
  Little is known about the population-based burden of ED care for COPD.
  
  
  METHODS
  We analyzed statewide ED surveillance system data to quantify the frequency of COPD-related ED visits, hospital admissions, and comorbidities.
  
  
  RESULTS
  In 2008 to 2009 in North Carolina, 97,511 COPD-related ED visits were made by adults ≥ 45 years of age, at an annual rate of 13.8 ED visits/1,000 person-years. Among patients with COPD (n = 33,799), 7% and 28% had a COPD-related return ED visit within a 30- and 365-day period of their index visit, respectively. Compared with patients on private insurance, Medicare, Medicaid, and noninsured patients were more likely to have a COPD-related return visit within 30 and 365 days and have three or more COPD-related visits within 365 days. There were no differences in return visits by sex. Fifty-one percent of patients with COPD were admitted to the hospital from the index ED visit. Subsequent hospital admission risk in the cohort increased with age, peaking at 65 to 69 years (risk ratio [RR], 1.41; 95% CI, 1.26-1.57); there was no difference by sex. Patients with congestive heart failure (RR, 1.29; 95% CI, 1.22-1.37), substance-related disorders (RR, 1.35; 95% CI, 1.13-1.60), or respiratory failure/supplemental oxygen (RR, 1.25; 95% CI, 1.19-1.31) were more likely to have a subsequent hospital admission compared with patients without these comorbidities.
  
  
  CONCLUSIONS
  The population-based burden of COPD-related care in the ED is significant. Further research is needed to understand variations in COPD-related ED visits and hospital admissions.
authors.affiliation: Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill; Gillings School of Global Public Health, Center for Environmental Medicine, Asthma, and Lung Biology, University of North Carolina at Chapel Hill, Chapel Hill. Electronic address: Karin_Yeatts@unc.edu.
authors.forename: Karin B
authors.initials: KB
authors.lastname: Yeatts
authors.affiliation: Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill; Carolina Center for Health Informatics, Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Lippmann
authors.affiliation: Carolina Center for Health Informatics, Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill.
authors.forename: Anna E
authors.initials: AE
authors.lastname: Waller
authors.affiliation: Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill.
authors.forename: Kristen
authors.initials: K
authors.lastname: Hassmiller Lich
authors.affiliation: Carolina Center for Health Informatics, Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill; School of Medicine, School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill.
authors.forename: Debbie
authors.initials: D
authors.lastname: Travers
authors.affiliation: Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill; Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC.
authors.forename: Morris
authors.initials: M
authors.lastname: Weinberger
authors.affiliation: Department of Pulmonary Diseases and Critical Care Medicine, University of North Carolina at Chapel Hill, Chapel Hill.
authors.forename: James F
authors.initials: JF
authors.lastname: Donohue
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D049690:History, Ancient; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009657:North Carolina / Q000453:epidemiology; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology* / Q000628:therapy; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D017678:Sex Distribution