Chest
Volume 147, Issue 4, April 2015, Pages 989-998
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Original Research: COPD Featured
Hospital Discharges, Readmissions, and ED Visits for COPD or Bronchiectasis Among US Adults

https://doi.org/10.1378/chest.14-2146Get rights and content

BACKGROUND:Numbers and rates of hospitalizations and ED visits by patients with COPD are important metrics for surveillance purposes. The objective of this study was to examine trends in these rates from 2001 to 2012 among adults aged ≥ 18 years in the United States.

METHODS:Data from the Nationwide Inpatient Sample (NIS) and Nationwide Emergency Department Sample (NEDS) were examined for temporal trends in the numbers and rates of hospitalizations by patients with COPD or bronchiectasis, mean length of stay, in-hospital case-fatality rate, 30-day readmission rate, and numbers and rates of ED visits.

RESULTS:The national number of discharges with COPD or bronchiectasis as the principal diagnosis was about 88,000 higher in 2012 than in 2001, but the age-adjusted rate of discharges did not change significantly (range, 242.7-286.0 per 100,000 population,Ptrend = .554). In contrast, hospitalization rates for common cardiovascular disorders, pneumonia, and lung cancer decreased significantly by 27% to 68%, whereas the mean charge doubled and mean cost increased by 40%. From 2006 to 2011, the numbers of ED visits increased from 1,480,363 to 1,787,612. The age-adjusted rate increased nonsignificantly from 654 to 725 per 100,000 population (Ptrend = .072).

CONCLUSIONS:Despite many local and national efforts to reduce the burden of COPD, total hospitalizations and ED visits over the past decade have increased for COPD, and the age-adjusted rates of hospitalizations and ED visits for COPD or bronchiectasis have not changed significantly in the United States.

Section snippets

Materials and Methods

The Healthcare Cost and Utilization Project (HCUP) comprises a series of national and state-level databases.3 This study used data from the Nationwide Inpatient Sample (NIS) and the Nationwide Emergency Department Sample (NEDS) database. This study was exempt from institutional review.

The NIS is created by drawing a stratified probability sample of hospitals drawn from State Inpatient Databases that include hospitalizations by patients with Medicare, Medicaid, private insurance, and the

Results

The weighted number of hospital discharges for COPD and bronchiectasis ranged from 534,398 to 692,364 (Fig 1). Of the numbers of combined COPD and bronchiectasis hospitalizations, 98.1% to 98.6% were for COPD (ICD-9 codes 490, 491, 492, 496). The average annual number of discharges was about 100,000 higher from 2008 to 2012 than from 2001 to 2007. The age-adjusted rate of discharges ranged from 242.7 to 286.0 per 100,000 population and showed no clear trend (Ptrend = .554) (Table 1).

Discussion

The current study, which provides the most up-to-date statistics, shows no significant trend in the age-adjusted rates of hospital discharges from 2001 to 2012 or ED visits from 2006 to 2011 for COPD or bronchiectasis. The persistence of these rates in the face of large declines in the prevalence of smoking is a bit perplexing but underscores the protracted nature of COPD. Significantly decreasing trends were found for mean length of stay and for the in-hospital case-fatality rate.

The lack of

Acknowledgments

Author contributions:E. S. F. had full access to all of the data in the study, takes responsibility for the integrity of the data and the accuracy of the analysis, and is responsible for the study concept and design, data acquisition, analysis, and interpretation, and manuscript preparation.

Financial/nonfinancial disclosures:The author has reported toCHESTthat no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

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    FOR EDITORIAL COMMENT SEE PAGEFUNDING/SUPPORT:The author has reported toCHESTthat no funding was received for this study.Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.

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