Predicting the Medical Utilization and Mortality of Patients With COPD Using the GOLD Criteria

Abstract

Background: Chronic lower respiratory tract disease has been the seventh most common cause of death in Taiwan for decades. Previous studies have revealed relationships between the stages of COPD and medical utilization and mortality. However, such research in Taiwan is lacking. Therefore, we investigated the association between the Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages of COPD versions 2007 and 2011 and medical utilization and mortality among patients with COPD to compare the effectiveness of these two versions.

Methods: This retrospective study used the clinical database of a medical center in central Taiwan from 2011 to 2017. A total of 613 patients with COPD were identified. Independent variables comprised the 2007 and 2011 versions of the GOLD stages of COPD, demographic characteristics, health status, and physician seniority. Dependent variables included total medical expenses, average duration of hospitalization, and mortality. Statistical methods included binomial logistic regression and the general linear model (GLM).

Results: The total medical costs during the observation period for patients with COPD averaged NT$292,455.60. The average duration of hospitalization was 9.7 days. The mortality rate was 9.6%. The adjusted logistic regression analysis indicated that compared with patients with Grade 1 disease as per the 2007 version, patients in 2007 Grade 4 had significantly higher odds of death (OR = 4.07, P = .02). The adjusted GLM analysis revealed that patients in 2011 Group D had a significantly longer duration of hospitalization than those in 2011 Group A version (P = .04). Regarding the total medical costs and accuracy of mortality prediction, no differences were found between the 2007 and 2011 versions. Complications were significantly associated with the total medical utilization and average duration of hospitalization.

Conclusions: Higher 2011 GOLD stages of COPD were associated with an increased average duration of hospitalization, whereas higher 2007 GOLD stages of COPD were associated with an increased risk of mortality. This study suggests that both versions of GOLD should be used together in the classification of patients with COPD to help clinicians better evaluate their prognosis, such as mortality and treatment. The findings serve a reference for medical institutions to prioritize high-risk patients with COPD and allocate resources appropriately for preventive interventions.