Factors Related with Hospital Attendance and Mortality in Patients with COPD: A Case–Control Study in a Real-Life Setting

Abstract

María Estrella López-Pardo,1 Cristina Candal-Pedreira,2 Luis Valdés-Cuadrado,3 Cristina Represas-Represas,4 Alberto Ruano-Ravina,2,5,6 Mónica Pérez-Ríos2,5,6 1Department of Planning and Health Reform, Galician Health Service, Santiago de Compostela, Spain; 2Department of Preventive Medicine and Public Health, School of Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain; 3Department of Pulmonology, University Clinical Teaching Hospital of Santiago de Compostela, Santiago de Compostela, Spain; 4Respiratory Medicine, Alvaro Cunqueiro University Teaching Hospital, Vigo, Spain; 5Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública/CIBERESP), Madrid, Spain; 6Health Research Institute of Santiago de Compostela (Instituto de Investigación Sanitaria de Santiago de Compostela - IDIS), Santiago de Compostela, SpainCorrespondence: Alberto Ruano-Ravina, Departamento de Medicina Preventiva y Salud Pública, Facultad de Medicina, University of Santiago de Compostela, C/ San Francisco s/n, Santiago de Compostela, 15782, Spain, Tel [phone], Fax [phone], Email [email protected]: The rising trend in hospital admissions among patients with chronic obstructive pulmonary disease (COPD) is worrying, not only because of the increasing costs, but also because of the worsening quality of life. We aimed to identify the predictive factors of hospital admission, re-admission and mortality of COPD patients through using information exclusively registered in electronic clinical records.Methods: We conducted a population-based case–control study. All data were sourced from the different information systems comprising the Galician Health Service electronic record database. We included in the study patients diagnosed with COPD (code R95 in the medical record), ≥ 35 years old and with at least one spirometry performed ≤ 3 years prior inclusion. We fitted three logistic regression models, each one to ascertain the factors that influence the probability of admission, re-admission, and mortality, and calculated odds ratios (OR) with their 95% confidence intervals (95% CI).Results: COPD patients were admitted due to respiratory causes a mean of 1.51 times across the period December 2016–December 2017, with 55% requiring re-admission in the next 90 days. The factor most closely associated with the re-admission profile was home oxygen therapy (OR 3.06 95% CI 2.42– 3.87), followed by male gender (OR 2.01 95% CI 1.48– 2.72), a CHA2D-VASc scale score > 2 (OR 1.28 95% CI 1.16– 1.42), and severity by clinical risk group stratification (OR 1.14 95% CI 1.04– 1.26). Male sex (OR 1.47 CI 95% 1.04– 2.09), having been readmitted ≥ 2 times (OR 1.34 CI 95% 1.11– 1.61) and being ≥ 70 years old (OR 1.05 CI 95% 1.03– 1.08) increase the probability of dying from COPD during the study period.Conclusion: These results confirm the complexity of management of COPD exacerbations, and indicate the need to establish strategies that would ensure continuity of care after hospital admission, with the aim of preventing re-admissions and death.Keywords: case–control study, COPD, hospital discharge, mortality

Keywords

• case-control study
• copd
• hospital discharge
• mortality