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Original Research: COPD |

Population-Based Burden of COPD-Related Visits in the EDCOPD-Related Visits in the ED: Return ED Visits, Hospital Admissions, and Comorbidity Risks

Karin B. Yeatts, PhD; Steven J. Lippmann, MSPH; Anna E. Waller, ScD; Kristen Hassmiller Lich, PhD; Debbie Travers, PhD, RN; Morris Weinberger, PhD; James F. Donohue, MD, FCCP
Author and Funding Information

From the Department of Epidemiology (Dr Yeatts and Mr Lippmann) and the Department of Health Policy and Management (Drs Hassmiller Lich and Weinberger), Gillings School of Global Public Health, the Center for Environmental Medicine, Asthma, and Lung Biology (Dr Yeatts), the Carolina Center for Health Informatics, Department of Emergency Medicine (Drs Waller and Travers and Mr Lippmann), and the Department of Pulmonary Diseases and Critical Care Medicine (Dr Donohue), School of Medicine, and the School of Nursing (Dr Travers), University of North Carolina at Chapel Hill, Chapel Hill; and the Center for Health Services Research in Primary Care (Dr Weinberger), Durham VA Medical Center, Durham, NC.

Correspondence to: Karin B. Yeatts, PhD, CB#7435, Department of Epidemiology, McGavran-Greenberg Hall, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599-7435; e-mail: Karin_Yeatts@unc.edu


Funding/Support: The statistical analysis for this research was partially supported by a University of North Carolina, Gillings School of Global Public Health Gillings Innovation Grant. Drs Lich and Weinberger’s time was partially supported by the National Center for Research Resources [Award KL2RR025746 to Dr Lich], a VA Senior Research Career Scientist Award from the Health Services Research and Development Service [RCS 91-408] (Dr Weinberger). North Carolina Disease Event Tracking and Epidemiologic Collection Tool data were provided by the North Carolina Public Health Data Group.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;144(3):784-793. doi:10.1378/chest.12-1899
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Background:  Little is known about the population-based burden of ED care for COPD.

Methods:  We analyzed statewide ED surveillance system data to quantify the frequency of COPD-related ED visits, hospital admissions, and comorbidities.

Results:  In 2008 to 2009 in North Carolina, 97,511 COPD-related ED visits were made by adults ≥ 45 years of age, at an annual rate of 13.8 ED visits/1,000 person-years. Among patients with COPD (n = 33,799), 7% and 28% had a COPD-related return ED visit within a 30- and 365-day period of their index visit, respectively. Compared with patients on private insurance, Medicare, Medicaid, and noninsured patients were more likely to have a COPD-related return visit within 30 and 365 days and have three or more COPD-related visits within 365 days. There were no differences in return visits by sex. Fifty-one percent of patients with COPD were admitted to the hospital from the index ED visit. Subsequent hospital admission risk in the cohort increased with age, peaking at 65 to 69 years (risk ratio [RR], 1.41; 95% CI, 1.26-1.57); there was no difference by sex. Patients with congestive heart failure (RR, 1.29; 95% CI, 1.22-1.37), substance-related disorders (RR, 1.35; 95% CI, 1.13-1.60), or respiratory failure/supplemental oxygen (RR, 1.25; 95% CI, 1.19-1.31) were more likely to have a subsequent hospital admission compared with patients without these comorbidities.

Conclusions:  The population-based burden of COPD-related care in the ED is significant. Further research is needed to understand variations in COPD-related ED visits and hospital admissions.

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