Healthcare Utilization in Patients with Chronic Obstructive Pulmonary Disease Discharged from Coronavirus 2019 Hospitalization

Abstract

Daniel Puebla Neira,1 Mohammed Zaidan,2 Shawn Nishi,2 Alexander Duarte,2 Christopher Lau,1 Sairam Parthasarathy,3 Jiefei Wang,4 Yong-Fang Kuo,4 Gulshan Sharma2 1Division of Pulmonary, Critical Care and Sleep Medicine, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA; 2Division of Pulmonary Critical Care and Sleep Medicine, University of Texas Medical Branch, Galveston, TX, USA; 3Division of Pulmonary, Critical Care and Sleep Medicine, University of Arizona College of Medicine-Tucson, Tucson, AZ, USA; 4Department of Biostatistics & Data Science, University of Texas Medical Branch, Galveston, TX, USACorrespondence: Daniel Puebla Neira, Division of Pulmonary, Critical Care and Sleep Medicine, University of Arizona College of Medicine-Phoenix, 1111 E McDowell Road, Phoenix, AZ, 85006, USA, Email [email protected]: There is concern that patients with chronic obstructive pulmonary disease (COPD) are at greater risk of increased healthcare utilization (HCU) following Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-COV-2) infection.Objective: To assess whether COPD is an independent risk factor for increased post-discharge HCU.Methods: We conducted a retrospective cohort study of patients with COPD discharged home from a hospitalization due to Coronavirus Disease 2019 (COVID-19) between April 1, 2020, and March 31, 2021, using Optum’s de-identified Clinformatics® Data Mart Database (CDM). COVID-19 was identified by an International Classification of Diseases, tenth revision, clinical modification (ICD-10-CM) diagnosis code of U07.1. The primary outcome was HCU (ie, emergency department (ED) visits, readmissions, rehabilitation/skilled nursing facility (SNF) visits, outpatient office visits, and telemedicine visits) nine months post-discharge after COVID-19 hospitalization (from here on “post-discharge”) in patients with COPD compared to HCU of patients without COPD. Poisson regression modeling was used to calculate relative risk (RR) and confidence interval (CI) for COPD, adjusted for the other covariates.Results: We identified a cohort of 160,913 patients hospitalized with COVID-19, with 57,756 discharged home and 14,622 (25.3%) diagnosed with COPD. Patients with COPD had a mean age of 75.48 years (± 9.49); 55.5% were female and 70.9% were White. Patients with COPD had an increased risk of HCU in the nine months post-discharge after adjusting for the other covariates. Risk of ED visits, readmissions, length of stay during readmission, rehabilitation/SNF visits, outpatient office visits, and telemedicine visits were increased by 57% (RR 1.57; 95% CI 1.53– 1.60), 50% (RR 1.50; 95% CI 1.46– 1.54), 55% (RR 1.55; 95% CI 1.53– 1.56), 18% (RR 1.18; 95% CI 1.14– 1.22), 16% (RR 1.16; 95% CI 1.16– 1.17), and 28% (RR 1.28; 95% CI 1.24– 1.31), respectively. Younger patients (ages 18 to 65 years), women, and Hispanic patients with COPD showed an increased risk for post-discharge HCU.Conclusion: Patients with COPD hospitalized with COVID-19 experienced increased HCU post-discharge compared to patients without COPD.Keywords: COPD, Healthcare Utilization disease, COVID-19

Keywords

• copd
• healthcare utilization
• covid-19.