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Original Research: COPD |

Total and State-Specific Medical and Absenteeism Costs of COPD Among Adults Aged ≥ 18 Years in the United States for 2010 and Projections Through 2020COPD Costs FREE TO VIEW

Earl S. Ford, MD, MPH; Louise B. Murphy, PhD; Olga Khavjou, MA; Wayne H. Giles, MD; James B. Holt, PhD; Janet B. Croft, PhD
Author and Funding Information

From the Division of Population Health (Drs Ford, Murphy, Giles, Holt, and Croft), National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA; and RTI International (Ms Khavjou), Research Triangle Park, NC.

CORRESPONDENCE TO: Earl S. Ford, MD, MPH, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS F78, Atlanta, GA 30341; e-mail: eford@cdc.gov


FOR EDITORIAL COMMENT SEE PAGE 3

FUNDING/SUPPORT: This work was supported by the Centers for Disease Control and Prevention [Contract No. 200-2008-27958-0002 task order 00006].

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


Chest. 2015;147(1):31-45. doi:10.1378/chest.14-0972
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BACKGROUND:  COPD remains a leading cause of morbidity and mortality. The objectives of this study were to estimate (1) national US COPD-attributable annual medical costs by payer (direct) and absenteeism (indirect) in 2010 and projected medical costs through 2020 and (2) state-specific COPD-attributable medical and absenteeism costs in 2010.

METHODS:  We used the 2006-2010 Medical Expenditure Panel Survey, the 2004 National Nursing Home Survey, and 2010 Centers for Medicare and Medicaid Services data to generate cost estimates and 2010 census data to project medical costs through 2020.

RESULTS:  In 2010, total national medical costs attributable to COPD and its sequelae were estimated at $32.1 billion, and total absenteeism costs were $3.9 billion, for a total burden of COPD-attributable costs of $36 billion. An estimated 16.4 million days of work were lost because of COPD. Of the medical costs, 18% was paid for by private insurance, 51% by Medicare, and 25% by Medicaid. National medical costs are projected to increase from $32.1 billion in 2010 to $49.0 billion in 2020. Total state-specific costs in 2010 ranged from $49.1 million in Wyoming to $2.8 billion in California: medical costs ranged from $42.5 million in Alaska to $2.5 billion in Florida and absenteeism costs ranged from $8.4 million in Wyoming to $434.0 million in California.

CONCLUSIONS:  Costs attributable to COPD and its sequelae are substantial and are projected to increase through 2020. Evidence-based interventions that prevent tobacco use and reduce the clinical complications of COPD may result in potential decreased COPD-attributable costs.

Figures in this Article

COPD continues to be a major cause of morbidity and mortality in the United States.1 Approximately 6.5% of US adults (an estimated 15 million) report ever having been diagnosed with COPD.2 In 2008, chronic lower respiratory disease, of which COPD is the largest condition, became the third leading cause of death.3 In 2010, almost 700,000 patients were hospitalized for a first-listed diagnosis of COPD, 10.3 million outpatient visits for COPD took place, and 1.5 million ED visits occurred.1 Furthermore, COPD is a major contributor to work absenteeism.46 These considerations indicate that the economic costs attributable to COPD are substantial.

Previous estimates of medical costs in the United States have indicated the high costs incurred by people with COPD: $37.2 billion in 20047 and $42.6 billion in 20078; costs in 2010 were projected to be $49.9 billion.9 Although costs for 2008 were calculated using the population-based US Medical Expenditure Panel Survey (MEPS) and included the indirect costs of mortality derived from the National Vital Statistics System, these costs were an aggregation of COPD and asthma combined ($68 billion).10 Because estimates of COPD-attributable costs indicate the potential cost savings associated with the prevention of COPD, an updated estimate that specifically quantifies the portion attributable to COPD is needed. Furthermore, COPD is a recognized risk factor for multiple costly chronic conditions such as cardiovascular disease, pneumonia, and depression, and, therefore, an estimate of the attributable cost of COPD should include its sequelae.

Because of geographic variation in COPD prevalence, hospitalizations, and mortality,1 the economic costs of COPD are also likely to demonstrate state variations. Yet, state-specific estimates of costs attributable to COPD, which are invaluable to comprehensively defining state-specific burdens of COPD, have not been available. Consequently, this study’s objectives were to produce (1) national US COPD-attributable annual medical costs by payer (direct) and absenteeism (indirect) in 2010 and projected medical costs through 2020 in adults aged ≥ 18 years and (2) state-specific COPD-attributable medical and absenteeism costs in 2010.

Detailed methods are described in the supplement (e-Appendix 1). The main data source for generating baseline and projected costs was the 2006 to 2010 MEPS.11 Supplemental data sources included the National Nursing Home Survey, the US Census Bureau, and the Centers for Medicare and Medicaid Services. Estimates are limited to adults aged ≥ 18 years. Because this study used public-use data sets, no subject approval was needed.

COPD-Attributable Medical Expenditures

A description of the methods used to generate the cost estimates and projections has already been published.1215 We calculated national and state-specific annual COPD-attributable medical costs using the following six steps. First, we calculated, by state, the number of adults in each of the four payer categories (all payers, including uninsured; Medicare; Medicaid; and private insurance). Second, we estimated, for each payer category, the proportion of adults with COPD by 2010 census region (Northeast, South, Midwest, and West). Third, we calculated the number of adults with COPD in each payer category in each state by multiplying the number of adults in the state-payer category (from step one) by the corresponding region-specific proportion of adults with COPD (from step 2). Fourth, we estimated per person COPD-attributable medical expenditures for each payer using regression analyses. Fifth, for each state and payer, we generated total COPD-attributable medical expenditures in each sex/age cell by multiplying the number in the state population with COPD (from step 3) by the per person COPD-attributable medical cost (from step 4). Sixth, we summed the state and payer-specific costs across the eight sex/age categories (from step 5) to calculate the total medical costs by state and payer.

Projections of COPD-Attributable Medical Expenditures

We calculated projections of national annual COPD-attributable medical costs for every year between 2010 and 2020 by multiplying the projected number of people with COPD in each sex/age category in every year by the 2010 sex and age-specific per person COPD-attributable medical cost.

COPD-Attributable Absenteeism Costs

We calculated the national and state-specific annual COPD-attributable absenteeism costs for 2010 using steps similar to those described for medical expenditures. Absenteeism cost estimates were also inflated to 2012 dollars. Employment status and the number of days of absenteeism due to illness or injury were based on self-reported information from the MEPS Household Component Survey. Average daily earnings were obtained from the 2010 Current Population Survey.

The data from MEPS show that participants with COPD were older, more likely to be women, and more likely to be non-Hispanic White (Table 1). Furthermore, almost 78% of participants with COPD had one or more comorbidities, compared with about 50% of participants without COPD. In descending order, the most common comorbidities among participants with COPD were hypertension, arthritis, dyslipidemia, asthma, and injuries.

Table Graphic Jump Location
TABLE 1 ]  Selected Characteristics by COPD Status Among Adults Aged ≥ 18 y, Medical Expenditure Panel Survey 2006-2010

Data are presented as % unless indicated otherwise.

a 

COPD-related comorbidities include congestive heart failure, coronary heart disease, other heart diseases, stroke, asthma, pneumonia, depression, and other mental health and/or substance abuse problems.

b 

Comorbidities not related to COPD include hypertension, dyslipidemia, diabetes, cancer, arthritis, back problems, injuries, renal failure, HIV/AIDS, skin disorders, and pregnancy.

Average Per Person Medical Expenditures

The average annual per person medical costs were $9,800 among persons with COPD and $3,770 among those without COPD (Table 2). Among adults both with and without COPD, expenditures increased with age and were higher among women than among men. The unadjusted difference of $6,030 narrowed substantially to $3,120 after adjusting for demographics and for demographics plus comorbidities but excluding associated medical conditions.

Table Graphic Jump Location
TABLE 2 ]  Average Per Person Medical Expenditures for People With and Without COPD, United States 2010

Per person costs reported in this table are from the Medical Expenditure Panel Survey and do not include adjustments for long-term care. Per person costs are rounded to the nearest $10.

a 

Demographic factors include age, age squared, sex, race/ethnicity, education, family income, sources of health insurance, and year.

b 

Select medical conditions include hypertension, dyslipidemia, diabetes, cancer, arthritis, back problems, injuries, renal failure, HIV/AIDS, skin disorders, and pregnancy.

c 

Medical conditions include congestive heart failure, coronary heart disease, other heart diseases, hypertension, stroke, dyslipidemia, diabetes, cancer, asthma, pneumonia, arthritis, back problems, injuries, depression, other mental health and/or substance abuse problems, renal failure, HIV/AIDS, skin disorders, and pregnancy.

Total Medical Costs

In 2010, the total medical costs incurred by people with COPD were $101 billion dollars. These are costs specific to COPD and those related to other medical conditions. The total unadjusted medical costs attributable to COPD were $72.7 billion. These represent the difference in the per person medical costs multiplied by the estimated total number of people with COPD.

Because of demographic differences between people with and without COPD and the high prevalence of comorbidities among people with COPD (Table 1), we examined the effect of adjusting for these differences on medical cost estimates (Table 3). After adjusting for demographic differences, the estimated medical costs were $59.3 billion. Additional adjustment for single comorbidities reduced the estimated medical costs to as low as $46.7 billion (adjusted for arthritis only) (Table 3). After adjusting for all 11 medical conditions not thought to be COPD sequelae (hypertension, dyslipidemia, diabetes, cancer, arthritis, back problems, injuries, renal failure, HIV/AIDS, skin disorders, and pregnancies), the medical costs were $32.1 billion. Costs increased from about $3.4 billion among people aged 18 to 44 years to $19.6 billion among people aged ≥ 65 years and were higher among women ($21.0 billion) than among men ($11.1 billion) (Fig 1).

Table Graphic Jump Location
TABLE 3 ]  Total Costs of COPD From Regression Model Controlling for Demographica Characteristics and the Following Medical Conditions, United States 2010
a 

Demographic factors include age, age squared, sex, race/ethnicity, education, family income, sources of health insurance, and year.

Figure Jump LinkFigure 1 –  Total COPD costs (in $1,000s). A, Adjusted for demographic factors. B, Adjusted for demographic factors and 11 medical conditions. C, Adjusted for demographic factors and 19 medical conditions.Grahic Jump Location
State-Specific Costs

The prevalence of treated COPD was 3.1% for the United States and ranged from 2.1% to 3.6% among the states. The treated prevalence is lower than published estimates of COPD prevalence because a proportion of the adults with COPD did not incur medical expenses and thus were not counted in estimating the prevalence of treated COPD. State-specific medical costs ranged from $42.5 million in Alaska to $2.5 billion in Florida (Table 4). Per person COPD-attributable annual medical costs ranged from $2,590 in Alaska to $3,390 in Pennsylvania.

Table Graphic Jump Location
TABLE 4 ]  Medical Treatment Costsa for COPD Among Adults Aged ≥ 18 y in 2010, by State, United States
a 

Costs are expressed in 2012 US dollars.

b 

Rounded to the nearest 100.

c 

Demographic factors include age, age squared, sex, race/ethnicity, education, family income, sources of health insurance, and year.

d 

Select medical conditions include hypertension, dyslipidemia, diabetes, cancer, arthritis, back problems, injuries, renal failure, HIV/AIDS, skin disorders, and pregnancy.

e 

Medical conditions include congestive heart failure, coronary heart disease, other heart diseases, hypertension, stroke, dyslipidemia, diabetes, cancer, asthma, pneumonia, arthritis, back problems, injuries, depression, other mental health and/or substance abuse problems, renal failure, HIV/AIDS, skin disorders, and pregnancy.

f 

Rounded to the nearest $10.

The state-specific and national distribution of medical costs by payer is presented in Table 5. Of the total national medical costs, 18% were borne by private insurance, 51% by Medicare, and 25% by Medicaid. The remaining costs include those paid out of pocket and by other federal and state programs besides Medicare and Medicaid (Veterans Administration, Tricare, and so forth).

Table Graphic Jump Location
TABLE 5 ]  Total Medical Treatment Costsa Attributable to COPD in 2010, by State and Payer,b United States
a 

Costs are expressed in 2012 US dollars. Sums of the total costs across subpopulations may not equal the overall total costs because of rounding.

b 

Payer populations are not mutually exclusive.

c 

Demographic factors include age, age squared, sex, race/ethnicity, education, family income, sources of health insurance, and year.

d 

Select medical conditions include hypertension, dyslipidemia, diabetes, cancer, arthritis, back problems, injuries, renal failure, HIV/AIDS, skin disorders, and pregnancy.

e 

Medical conditions include congestive heart failure, coronary heart disease, other heart diseases, hypertension, stroke, dyslipidemia, diabetes, cancer, asthma, pneumonia, arthritis, back problems, injuries, depression, other mental health and/or substance abuse problems, renal failure, HIV/AIDS, skin disorders, and pregnancy.

Costs Due to Absenteeism

Estimates of days of lost productivity were generally similar across the states (an average of 3.2 days lost). In all, an estimated 16.4 million days of absenteeism were attributed to COPD. National COPD-attributable costs due to absenteeism were $3.9 billion, and the state-specific costs ranged from $5.7 million in Wyoming to $434.1 million in California (Table 6).

Table Graphic Jump Location
TABLE 6 ]  Costsa of Absenteeism for COPD in 2010, by State, United States
a 

Costs are expressed in 2012 US dollars.

b 

Rounded to the nearest 100.

c 

Demographic factors include age, age squared, sex, race/ethnicity, education, family income, sources of health insurance, and year.

d 

Select medical conditions include hypertension, dyslipidemia, diabetes, cancer, arthritis, back problems, injuries, renal failure, HIV/AIDS, skin disorders, and pregnancy.

e 

Medical conditions include congestive heart failure, coronary heart disease, other heart diseases, hypertension, stroke, dyslipidemia, diabetes, cancer, asthma, pneumonia, arthritis, back problems, injuries, depression, other mental health and/or substance abuse problems, renal failure, HIV/AIDS, skin disorders, and pregnancy.

Projected Costs to 2020

National costs were projected to increase from $32.1 billion in 2010 to $49.0 billion in 2020. This represents an increase of 53% (Table 7).

Table Graphic Jump Location
TABLE 7 ]  Projections of Excess National Medical Treatment Costs Attributable to COPD, 2010-2020, United States
a 

Demographic factors include age, age squared, sex, race/ethnicity, education, family income, sources of health insurance, and year.

b 

Select medical conditions include hypertension, dyslipidemia, diabetes, cancer, arthritis, back problems, injuries, renal failure, HIV/AIDS, skin disorders, and pregnancy.

c 

Medical conditions include congestive heart failure, coronary heart disease, other heart diseases, hypertension, stroke, dyslipidemia, diabetes, cancer, asthma, pneumonia, arthritis, back problems, injuries, depression, other mental health and/or substance abuse problems, renal failure, HIV/AIDS, skin disorders, and pregnancies.

Using the most comprehensive approach to date, we estimated that costs attributable to COPD and its sequelae were about $32.1 billion in 2010. To our knowledge, our analyses provide the first estimates of state-specific costs for state officials, public health practitioners, and other stakeholders charged with reducing the burden of COPD.

The previously reported national estimates generated by the National Heart, Lung, and Blood Institute consist of direct costs, morbidity-associated costs, and mortality-associated costs.710 Those national estimates are based on data from several datasets, including MEPS, the National Nursing Home Survey, the National Ambulatory Medical Care Survey, and National Vital Statistics System Mortality Data, and represent costs among people with COPD rather than COPD-attributable costs. Therefore, these estimates, based on different data sources and statistical methodology, are not comparable to the current report of national estimates, which are specific to national medical treatment and absenteeism estimates.

Our estimated medical costs of COPD of $32.1 billion in 2010 differ from the projected costs totaling $29.5 billion in 2010 in the 2009 Chartbook.9 Because the chartbook does not provide the methodologic details used to generate the latter estimate, explaining the difference in the estimates is a difficult endeavor. Our estimate represents the excess medical costs incurred by adults with COPD, and our approach avoids double-counting of costs for comorbid conditions. Thus, our estimate provides a more accurate estimate of the medical costs that are attributable to COPD. Understanding the difference in the two approaches in estimating costs is critical in describing the true costs of COPD. An example may serve to illustrate the methodologic difference in estimating costs. If two adults, one with COPD and one without COPD, were involved in a motor vehicle accident that resulted in both being hospitalized for identical injuries and hospitalization costs, the cost of this hospitalization would be counted as a cost incurred by an adult with COPD under one approach, whereas the cost would not be counted as being related to COPD under the alternative approach favored by the current study. However, if the cost of treatment from the accident was higher for a person with COPD than for a person without COPD (holding all else equal), that additional cost would be attributed to COPD and its sequelae.

Another analysis based on commercially insured patients in the United States estimated that medical costs for this population were $15.7 billion in 2008 US dollars, representing $12.4 billion in direct health-care costs and $3.3 billion in pharmacy costs.16 From 2006 to 2009, medical costs for patients with evidence of COPD increased by 5% per year among Medicare beneficiaries and by 6% per year among commercially insured patients.17 Furthermore, hospitalization costs increased by 3% per year among Medicare beneficiaries but remained stable among commercially insured patients. The costs associated with ICU admissions remained stable in both populations.

Reducing the costs attributable to COPD and its sequelae can be accomplished through different but complementary approaches: primary prevention of COPD and secondary prevention of complications. Because approximately 75% of COPD is caused by smoking,18 the principal route to primary prevention is the prevention of smoking initiation, and smoking cessation among those who do smoke. The next biggest target of preventable disease is that caused by occupational and environmental exposures.

Once patients receive a diagnosis of COPD, optimizing their management may limit the costs attributable to COPD by avoiding acute exacerbations of their conditions, slowing the decline in pulmonary function, and reducing adverse symptoms. Current guidelines by the GOLD (Global Initiative for Chronic Obstructive Lung Disease) as well as guidelines by the American College of Physicians/American College of Chest Physicians (CHEST)/American Thoracic Society/European Respiratory Society provide state-of-the-science reports for the management of patients with COPD.19,20 These steps include eliminating and avoiding exposures known to cause COPD, maximizing the numbers of people who receive indicated vaccinations, and implementing recommended pharmacologic treatment. Because hospitalizations make up a large portion of the costs attributable to COPD, strategies to avoid hospitalizations should have a meaningful impact on costs.21 For example, evidence suggests that COPD-related hospitalizations can be reduced by appropriate pharmacologic management22,23 or by strengthening home-based management programs.2426 However, the impact of various pharmacologic options on health-care costs and health benefits is variable and requires careful evaluation.23,27 A review of interventions to reduce the rate of hospitalizations among long-term care facility residents noted that the most promising interventions included hiring more nurse practitioners and physician assistants, increasing the numbers of registered nurses who work in long-term care facilities, paying more attention to the transfer from the hospital back to the long-term care facility or home, favoring home health care over hospital care, and implementing policy interventions related to financial incentives.26

Additionally, low-cost, convenient, and evidence-based community programs have been designed to complement clinical care.28 For example, the Stanford Chronic Disease Self-Management Program was designed for people with chronic conditions including COPD, arthritis, and diabetes. This program has been proven empirically to result in sustained decreases in multiple adverse disease outcomes associated with COPD, including shortness of breath and depression.

Our study has several limitations. First, MEPS data are based on self-reported information and, therefore, are subject to misreporting. In a comparison of MEPS 2001-2003 data with Medicare data, for example, inpatient stays were reported accurately but ED visits and outpatient visits were underreported.29 Furthermore, several analyses have evaluated self-reported information about medical conditions by MEPS participants.3033 Second, uncertainty in the estimates arises from using a combination of several data sources and the different levels of geographic detail available in the source data. Third, because regression techniques are required to calculate the costs attributable to COPD, our results are themselves estimates. Of note is the effect of the set of medical conditions used as covariates in the regression models to generate costs and other estimates. Generally, our results illustrate that as more conditions are added to the regression models, “attributable” costs decrease. We conducted multiple series of analyses to examine the costs attributable to COPD across a range of adjustment variables including an estimate of costs attributable to COPD alone. We concluded that the latter underestimates the cost of COPD, which is a well-documented risk factor for multiple conditions (ie, it is in the chain of causation) and that the primary estimate of COPD-attributable costs should be represented by the cost of COPD and its sequelae. By presenting results from several series of analyses, we illustrated costs for a range of adjustment scenarios.

Fourth, we caution against conducting comparisons of our estimates across states; we used data from different levels of geographic detail across states because of small sample sizes for some age, sex, and state combinations. The majority of the variation in costs across states is driven by the differences in the demographic composition of the states. Furthermore, we produced state-based estimates of treated COPD prevalence from regional census data because of small sample sizes at the state level, and this approach underestimated the interstate variation in treated COPD prevalence.

Fifth, the current study includes estimates of medical costs and absenteeism only; we do not capture productivity losses from impaired productivity while at work (ie, presenteeism), premature mortality, or reductions in the quality of life associated with COPD. Sixth, although we projected excess COPD-attributable costs through the year 2020, such projections are subject to considerable uncertainty. Our projections reflect expected changes in the distribution of US residents by sex and age groups (ie, aging of the population) and historical medical growth. However, they assume no policy changes that could affect treatment costs. In projecting future COPD costs, we assumed that COPD prevalence and per person COPD-attributable costs within age and sex groups would remain unchanged. Depending on how future changes in these two variables play out, our results may underestimate or overestimate future costs. Finally, these costs do not reflect state-level geographic variation in health-care use and practice patterns, which is a topic that should be the subject of future studies.

Our analyses provide, we believe for the first time, state-specific costs for COPD, which equip state public health practitioners with estimates of the economic burden of COPD within their borders and illustrate the potential medical and absenteeism costs savings to states through implementing state-level programs that are designed to prevent the onset of COPD (eg, tobacco prevention and cessation). The range of evidence-based strategies to prevent COPD and decrease its effects provides opportunities for clinical and public health practitioners to work together at the national and state levels to decrease the economic impact and improve the quality of life of people with COPD.

Author contributions: O. K. had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the analysis. E. S. F. and L. B. M. contributed to the study concept and design; O. K. contributed to data analysis; E. S. F., L. B. M., O. K., W. H. G., and J. B. C. contributed to the interpretation of the data; E. S. F. contributed to the study supervision; E. S. F., L. B. M., O. K., and J. B. C. contributed to the drafting of the manuscript; E. S. F., L. B. M., O. K., W. H. G., J. B. H., and J. B. C. contributed to the critical revision of the manuscript for important intellectual content; and W. H. G. and J. B. C. contributed to administrative, technical, or material support.

Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Role of sponsors: Funding from the Centers for Disease Control and Prevention to RTI International was used to perform the analyses at the Centers for Disease Control and Prevention facilities.

Other contributions: This work was performed at the Centers for Disease Control and Prevention and RTI International. The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Additional information: The e-Appendix can be found in the Supplemental Materials section of the online article.

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Zuvekas SH, Olin GL. Validating household reports of health care use in the medical expenditure panel survey. Health Serv Res. 2009;44(5 Pt 1):1679-1700. [CrossRef] [PubMed]
 
Cox BG, Iachan R. A comparison of household and provider reports of medical conditions. J Am Stat Assoc. 1987;82(400):1013-1018. [CrossRef]
 
US Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Center for Health Statistics. Evaluation of National Health Interview Survey diagnostic reporting. Vital Health Stat 2. 1994;2(120):1-116.
 
Johnson AE, Sanchez ME. Household and medical reports on medical conditions: National Medical Expenditure Survey. J Econ Soc Meas. 1993;19:199-223.
 
Machlin S, Cohen J, Elixhauser A, Beauregard K, Steiner C. Sensitivity of household reported medical conditions in the medical expenditure panel survey. Med Care. 2009;47(6):618-625. [CrossRef] [PubMed]
 

Figures

Figure Jump LinkFigure 1 –  Total COPD costs (in $1,000s). A, Adjusted for demographic factors. B, Adjusted for demographic factors and 11 medical conditions. C, Adjusted for demographic factors and 19 medical conditions.Grahic Jump Location

Tables

Table Graphic Jump Location
TABLE 1 ]  Selected Characteristics by COPD Status Among Adults Aged ≥ 18 y, Medical Expenditure Panel Survey 2006-2010

Data are presented as % unless indicated otherwise.

a 

COPD-related comorbidities include congestive heart failure, coronary heart disease, other heart diseases, stroke, asthma, pneumonia, depression, and other mental health and/or substance abuse problems.

b 

Comorbidities not related to COPD include hypertension, dyslipidemia, diabetes, cancer, arthritis, back problems, injuries, renal failure, HIV/AIDS, skin disorders, and pregnancy.

Table Graphic Jump Location
TABLE 2 ]  Average Per Person Medical Expenditures for People With and Without COPD, United States 2010

Per person costs reported in this table are from the Medical Expenditure Panel Survey and do not include adjustments for long-term care. Per person costs are rounded to the nearest $10.

a 

Demographic factors include age, age squared, sex, race/ethnicity, education, family income, sources of health insurance, and year.

b 

Select medical conditions include hypertension, dyslipidemia, diabetes, cancer, arthritis, back problems, injuries, renal failure, HIV/AIDS, skin disorders, and pregnancy.

c 

Medical conditions include congestive heart failure, coronary heart disease, other heart diseases, hypertension, stroke, dyslipidemia, diabetes, cancer, asthma, pneumonia, arthritis, back problems, injuries, depression, other mental health and/or substance abuse problems, renal failure, HIV/AIDS, skin disorders, and pregnancy.

Table Graphic Jump Location
TABLE 3 ]  Total Costs of COPD From Regression Model Controlling for Demographica Characteristics and the Following Medical Conditions, United States 2010
a 

Demographic factors include age, age squared, sex, race/ethnicity, education, family income, sources of health insurance, and year.

Table Graphic Jump Location
TABLE 4 ]  Medical Treatment Costsa for COPD Among Adults Aged ≥ 18 y in 2010, by State, United States
a 

Costs are expressed in 2012 US dollars.

b 

Rounded to the nearest 100.

c 

Demographic factors include age, age squared, sex, race/ethnicity, education, family income, sources of health insurance, and year.

d 

Select medical conditions include hypertension, dyslipidemia, diabetes, cancer, arthritis, back problems, injuries, renal failure, HIV/AIDS, skin disorders, and pregnancy.

e 

Medical conditions include congestive heart failure, coronary heart disease, other heart diseases, hypertension, stroke, dyslipidemia, diabetes, cancer, asthma, pneumonia, arthritis, back problems, injuries, depression, other mental health and/or substance abuse problems, renal failure, HIV/AIDS, skin disorders, and pregnancy.

f 

Rounded to the nearest $10.

Table Graphic Jump Location
TABLE 5 ]  Total Medical Treatment Costsa Attributable to COPD in 2010, by State and Payer,b United States
a 

Costs are expressed in 2012 US dollars. Sums of the total costs across subpopulations may not equal the overall total costs because of rounding.

b 

Payer populations are not mutually exclusive.

c 

Demographic factors include age, age squared, sex, race/ethnicity, education, family income, sources of health insurance, and year.

d 

Select medical conditions include hypertension, dyslipidemia, diabetes, cancer, arthritis, back problems, injuries, renal failure, HIV/AIDS, skin disorders, and pregnancy.

e 

Medical conditions include congestive heart failure, coronary heart disease, other heart diseases, hypertension, stroke, dyslipidemia, diabetes, cancer, asthma, pneumonia, arthritis, back problems, injuries, depression, other mental health and/or substance abuse problems, renal failure, HIV/AIDS, skin disorders, and pregnancy.

Table Graphic Jump Location
TABLE 6 ]  Costsa of Absenteeism for COPD in 2010, by State, United States
a 

Costs are expressed in 2012 US dollars.

b 

Rounded to the nearest 100.

c 

Demographic factors include age, age squared, sex, race/ethnicity, education, family income, sources of health insurance, and year.

d 

Select medical conditions include hypertension, dyslipidemia, diabetes, cancer, arthritis, back problems, injuries, renal failure, HIV/AIDS, skin disorders, and pregnancy.

e 

Medical conditions include congestive heart failure, coronary heart disease, other heart diseases, hypertension, stroke, dyslipidemia, diabetes, cancer, asthma, pneumonia, arthritis, back problems, injuries, depression, other mental health and/or substance abuse problems, renal failure, HIV/AIDS, skin disorders, and pregnancy.

Table Graphic Jump Location
TABLE 7 ]  Projections of Excess National Medical Treatment Costs Attributable to COPD, 2010-2020, United States
a 

Demographic factors include age, age squared, sex, race/ethnicity, education, family income, sources of health insurance, and year.

b 

Select medical conditions include hypertension, dyslipidemia, diabetes, cancer, arthritis, back problems, injuries, renal failure, HIV/AIDS, skin disorders, and pregnancy.

c 

Medical conditions include congestive heart failure, coronary heart disease, other heart diseases, hypertension, stroke, dyslipidemia, diabetes, cancer, asthma, pneumonia, arthritis, back problems, injuries, depression, other mental health and/or substance abuse problems, renal failure, HIV/AIDS, skin disorders, and pregnancies.

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Zuvekas SH, Olin GL. Validating household reports of health care use in the medical expenditure panel survey. Health Serv Res. 2009;44(5 Pt 1):1679-1700. [CrossRef] [PubMed]
 
Cox BG, Iachan R. A comparison of household and provider reports of medical conditions. J Am Stat Assoc. 1987;82(400):1013-1018. [CrossRef]
 
US Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Center for Health Statistics. Evaluation of National Health Interview Survey diagnostic reporting. Vital Health Stat 2. 1994;2(120):1-116.
 
Johnson AE, Sanchez ME. Household and medical reports on medical conditions: National Medical Expenditure Survey. J Econ Soc Meas. 1993;19:199-223.
 
Machlin S, Cohen J, Elixhauser A, Beauregard K, Steiner C. Sensitivity of household reported medical conditions in the medical expenditure panel survey. Med Care. 2009;47(6):618-625. [CrossRef] [PubMed]
 
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