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

Abstract

Rationale

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.

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© 2023 Puebla Neira et al. This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution - Non Commerical (unported, v3.0) License. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

Keywords:

• COPD
• Healthcare Utilization disease
• COVID-19

Abbreviations

CAD, Coronary Artery Disease; CHF, Congestive Heart Failure; CKD, Chronic Kidney Disease; COPD, Chronic Obstructive Pulmonary Disease; COVID-19, Coronavirus Disease 2019; DM, Diabetes Mellitus; ED, Emergency Department; ESRD, End-Stage Renal Disease; HCU, healthcare utilization; HTN, Hypertension; ICD-10-CM, International Classification for Diseases, tenth revision, clinical modification; ICU, Intensive Care Unit; LOS, length of stay; PCP, Primary Care Provider, SNF, skilled nursing facility, SD, Standard Deviation.

Author Contributions

All authors made a significant contribution to the work reported in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all areas; took part in drafting, revising, or critically reviewing the article; gave final approval of the version to be published; agreed on the journal to which the article has been submitted; and agreed to be accountable for all aspects of the work.

Disclosure

Dr. Puebla Neira reports support from NHLBI Advanced Respiratory Research for Equity (AiRE) - AZ-PRIDE Program grant (5R25HL126140-09) during the conduct of this study. Dr. Parthasarathy reports personal fees from Jazz Pharmaceuticals, Inc., UpToDate, Inc., grants from NIH (R25-HL126140, R33-HL151254; OT2-HL161847; R21-HD109777; C06-OD028307; HL140144; HL138377; 1OT2HL156812; OT2-HL156912 and OT2HL158287), grants from PCORI (DI-2018C2-13161, CER-2018C2-13262), grants from Department of Defense (W81XWH20C0051 and W81XWH2110025), grants from Pima County Health Department (CPIMP211275), grants from Arizona Commerce Authority (LTR DTD 021822), grants from Sergey Brin Foundation, grants from Philips, Inc. (0483-06-161311-73077), grants from Sommetrics, Inc., grants from American Academy of Sleep Medicine Foundation (AASMF; 169-SR-17), grants from Regeneron, Inc., grants from Centers for Disease Control (CDC FR Doc. 2021–19050), personal fees from AbbVie, Inc., and SaiOx, Inc., outside the submitted work; in addition, Dr. Parthasarathy has a patent US20160213879A1 licensed to SaiOx, Inc. Dr. Kuo reports grants from the UTMB Claude D. Pepper Older Americans Independence Center during the conduct of the study. The authors report no other conflicts of interest in this work.