title: 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 determined its outcome and financial impact using the National (Nationwide) Inpatient Sample (NIS) databases (2002-2010). Individuals aged ≥ 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 International Classification of Diseases-Ninth Revision (ICD-9) codes. The hospital outcomes and length of stay were determined. Multivariate logistic regression was used to identify the independent predictors of inpatient mortality. Overall acute exacerbation of COPD-related hospitalizations accounted for nearly 3.31% of all hospitalizations in the 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 < 0.001). Similarly, there was a significant decrease in average length of stay from 6.4 days in 2002 to 6.0 days in 2010 (slope -0.042, p < 0.001). 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.
authors.affiliation: a Division of Pulmonology and Critical Care Medicine, Department of Medicine, Wayne State University , Detroit , Michigan , USA.
authors.forename: Chetna
authors.initials: C
authors.lastname: Jinjuvadia
authors.affiliation: b Division of Gastroenterology and Hepatology, Department of Medicine, Henry Ford Health System , Detroit , Michigan , USA.
authors.forename: Raxitkumar
authors.initials: R
authors.lastname: Jinjuvadia
authors.affiliation: a Division of Pulmonology and Critical Care Medicine, Department of Medicine, Wayne State University , Detroit , Michigan , USA.
authors.forename: Chaitanya
authors.initials: C
authors.lastname: Mandapakala
authors.affiliation: c Department of Internal Medicine , Detroit Medical Center/Wayne State University , Detroit , Michigan , USA.
authors.forename: Navin
authors.initials: N
authors.lastname: Durairajan
authors.affiliation: d Division of Gastroenterology and Hepatology, Department of Medicine, and Roudebush Veterans Administration Medical Center , Indianapolis , Indiana , USA.
authors.forename: Suthat
authors.initials: S
authors.lastname: Liangpunsakul
authors.affiliation: a Division of Pulmonology and Critical Care Medicine, Department of Medicine, Wayne State University , Detroit , Michigan , USA.
authors.forename: Ayman O
authors.initials: AO
authors.lastname: Soubani
mesh_terms: D000208:Acute Disease; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000367:Age Factors; D000368:Aged; D018450:Disease Progression; D005260:Female; D017048:Health Care Costs / Q000639:trends*; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007902:Length of Stay / Q000191:economics / Q000639:trends*; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000191:economics* / Q000401:mortality*; D012737:Sex Factors; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data
keywords: COPD; NIS data; hospitalization costs; mortality