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Original Research: COPD |

Association of Psychological Disorders With 30-Day Readmission Rates in Patients With COPD

Gurinder Singh, MD; Wei Zhang, MS; Yong-Fang Kuo, PhD; Gulshan Sharma, MD, MPH
Author and Funding Information

FUNDING/SUPPORT: This work was supported by the Agency for Healthcare Research and Quality [Grant R01-HS020642], the Patient-Centered Outcomes Research Institute [Grant R24HS022134], the Clinical and Translational Science Award [Grant UL1TR000071] from the National Center for Advancing Translational Sciences, and the Claude D. Pepper Older Americans Independence Center [Grant 5P30-AG024832].

CORRESPONDENCE TO: Gurinder Singh, MD, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Texas Medical Branch, 301 University Blvd, 5.140 John Sealy Annex, Galveston, TX 77555-0561


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;149(4):905-915. doi:10.1378/chest.15-0449
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Background  There is a growing understanding of the prevalence and impact of psychological disorders on COPD. However, the role of these disorders in early readmission is unclear.

Methods  We analyzed data from 5% fee-for-service Medicare beneficiaries diagnosed with COPD (International Classification of Diseases, Ninth Revision code, 491.xx, 492.xx, 493.xx, and 496.xx) between 2001 and 2011 who were hospitalized with a primary discharge diagnosis of COPD or a primary discharge diagnosis of respiratory failure (518.xx and 799.1) with secondary diagnosis of COPD. We hypothesized that such psychological disorders as depression, anxiety, psychosis, alcohol abuse, and drug abuse are independently associated with an increased risk of 30-day readmission in patients hospitalized for COPD.

Results  Between 2001 and 2011, 135,498 hospitalizations occurred for COPD in 80,088 fee-for-service Medicare beneficiaries. Of these, 30,218 (22.30%) patients had one or more psychological disorders. In multivariate analyses, odds of 30-day readmission were higher in patients with COPD who had depression (OR, 1.34; 95% CI, 1.29-1.39), anxiety (OR, 1.43; 95% CI, 1.37-1.50), psychosis (OR, 1.18; 95% CI, 1.10-1.27), alcohol abuse (OR, 1.30; 95% CI, 1.15-1.47), and drug abuse (OR, 1.29; 95% CI, 1.11-1.50) compared with those who did not have these disorders. These psychological disorders increased amount of variation in 30-day readmission attributed to patient characteristics by 37%.

Conclusions  Psychological disorders like depression, anxiety, psychosis, alcohol abuse, and drug abuse are independently associated with higher all-cause 30-day readmission rates for Medicare beneficiaries with COPD.


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