title: [Importance of comorbidities in the anemia of COPD: Economic implications and 3-year survival analysis].
abstract: BACKGROUND
  Anemia occurs commonly in COPD and is associated with a poor prognosis. The role of comorbidities in this is suspected but poorly characterized and the economic implications of anemia combined with COPD in France have not been studied. The healthcare resource utilization and cost impact of anemia remain to be investigated.
  
  
  METHODS
  One hundred and fifty-one COPD patients attending a pulmonology outpatient department during a 6 months period were retrospectively selected if they had undergone a pulmonary function test, a blood gas analysis or a blood count. The Charlson comorbidity index, resource utilization and economic data from the year before the diagnosis of anemia were compared between anemic and non-anemic patients as well as 3-year survival analysis.
  
  
  RESULTS
  The prevalence of anemia was 18.5% and was not influenced by GOLD stage. The identification of anemia was similar from blood gas results and full blood count analysis. Comorbidities - mainly cardiovascular - were found in 86% of the anemic patients. The Charlson index was 5.4±2 in the anemic group compared to 4.1±1.5 in the non-anemic group (P<0.01). The Charlson index was the only predictive factor of anemia using logistic regression analysis. The 3-year mortality was 36% in the anemic versus 7% in the non-anemic group (P<0.05). The main factor identified which predicted 3-year mortality was the presence of anemia using logistic regression. Healthcare costs the year prior to the diagnosis of anemia were not significantly different between groups, but there was a tendency to an increase in the cost of the hospitalizations in the anemic group.
  
  
  CONCLUSIONS
  Anemia is easy to diagnose in COPD from the blood gas analysis. It is frequently linked to the presence of comorbidities - mainly cardiovascular diseases - and is the more important predictive factor of the 3-year mortality. There was a tendency towards an increase in the costs of hospitalizations in anemic patients but this remains to be confirmed in a larger economic study.
authors.affiliation: Université de Nantes, 44000 Nantes, France; L'institut du thorax, Inserm UMR1087, 44000 Nantes, France.
authors.forename: A
authors.initials: A
authors.lastname: Menou
authors.affiliation: Université de Nantes, 44000 Nantes, France; L'institut du thorax, Inserm UMR1087, 44000 Nantes, France.
authors.forename: M
authors.initials: M
authors.lastname: Pain
authors.affiliation: Caisse régionale d'assurance maladie, 44000 Nantes, France.
authors.forename: J
authors.initials: J
authors.lastname: Pivette
authors.affiliation: Service de pneumologie, groupement hospitalier Pitié-Salpêtrière, 75013 Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: Chenivesse
authors.affiliation: Université de Nantes, 44000 Nantes, France; L'institut du thorax, Inserm UMR1087, 44000 Nantes, France; Service de pneumologie, l'institut du thorax, CHU de Nantes, 44000 Nantes, France.
authors.forename: A
authors.initials: A
authors.lastname: Magnan
authors.affiliation: Université de Nantes, 44000 Nantes, France; L'institut du thorax, Inserm UMR1087, 44000 Nantes, France; Explorations fonctionnelles, CHU de Nantes, 44000 Nantes, France. Electronic address: arnaud.chambellan@chu-nantes.fr.
authors.forename: A
authors.initials: A
authors.lastname: Chambellan
mesh_terms: D000368:Aged; D000740:Anemia / Q000150:complications / Q000191:economics* / Q000453:epidemiology* / Q000401:mortality; D001784:Blood Gas Analysis; D002318:Cardiovascular Diseases / Q000191:economics / Q000453:epidemiology / Q000401:mortality; D015897:Comorbidity; D005260:Female; D005602:France / Q000453:epidemiology; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000191:economics* / Q000453:epidemiology* / Q000401:mortality; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D016019:Survival Analysis
keywords: Anemia; Anémie; Bronchopneumopathie chronique obstructive; Chronic obstructive pulmonary disease; Comorbidities; Comorbidités; Erythropoiesis; Haemoglobin; Hémoglobine; Érythropoïèse