SESSION TYPE: COPD: Outcomes
PRESENTED ON: Wednesday, October 24, 2012 at 02:45 PM - 04:15 PM
PURPOSE: Over the last 15 years, substantial advances have been made in the treatment chronic obstructive pulmonary disease (COPD), and comorbid cardiovascular disease (CVD). Although the efficacy of these treatments have been observed in randomized clinical trials, little information is available on whether they have resulted in reduced hospitalization rates among COPD patients. The purpose of this investigation was to examine changes in hospitalization rates for Medicare beneficiaries with COPD.
METHODS: This was a retrospective cohort study of 217,682 fee-for-service Medicare beneficiaries who were diagnosed with COPD between 1999 and 2008. We used Poisson regression analysis to assess changes in the risk of hospitalization for: all causes, COPD, COPD exacerbations, non-COPD respiratory disease, and cardiovascular disease (CVD). The following categories of hospitalization were classified according to the primary ICD-9 codes listed on the discharge diagnosis: all causes (all ICD-9 codes); COPD (491.x, 492.x, or 496.x); acute exacerbation of COPD (491.21); non-COPD respiratory (460.xx-519.xx, excluding aforementioned COPD codes); heart failure (402.01, 402.11, 402.91, 404.01, 404.11, 404.11, 404.91, 428, 404.03, 404.13, 404.93, 428.xx); and coronary artery disease (410.xx, 411.xx, 412.xx, 413.xx, 414.xx, V4581.xx, V4582.xx)
RESULTS: Over the 10-year study period, the relative risk of hospitalization for COPD patients, adjusted for age, sex, race, region and number of comorbidities declined from: 0.97 to 0.83, for all causes (P < .001); 0.95 to 0.83 for COPD (P < .001); 0.95 to 0.69 for acute exacerbation of COPD (P < .001); 0.90 to 0.69 for non-COPD respiratory disease (P < .001); 0.99 to 0.62 for CHF (P < .001); and 1.00 to 0.66 for CAD (P < .001).
CONCLUSIONS: The overall hospitalization rate for both COPD and comorbid CVD declined substantially from 1999 to 2008.
CLINICAL IMPLICATIONS: It is possible that improvements in COPD and CVD treatment contributed substantially to the observed reduction in hospitalizations among Medicare beneficiaries over the study period.
DISCLOSURE: The following authors have nothing to disclose: Jacques Baillargeon, Yong-Fang Kuo, Holly Holmes, Yue Wang, Gulshan Sharma
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