Comorbidities, mortality, and management of chronic obstructive pulmonary disease patients who required admissions to public hospitals in Hong Kong – computerized data collection and analysis

Abstract

Background

COPD is a common cause for hospital admission. Conventional studies of the epidemiology of COPD involved large patient number and immense resources and were difficult to be repeated. The present study aimed at assessing the utilization of a computerized data management system in the collection and analysis of the epidemiological and clinical data of a large COPD cohort in Hong Kong (HK).

Patients and methods

It was a computerized, multicenter, retrospective review of the characteristics of patients discharged from medical departments of the 16 participating hospitals with the primary discharge diagnosis of COPD in 1 year (2012). Comparison was made between the different subgroups in the use of medications, ventilatory support, and other health care resources. The mortality of the subjects in different subgroups was traced up to December 31, 2014. The top 10 causes of death were analyzed.

Results

In total, 9,776 subjects (82.6% men, mean age = 78 years) were identified. Of the 1,918 subjects with lung function coding, 85 (4.4%), 488 (25.5%), 808 (42.1%), and 537 (28.0%) subjects had the Global Initiative for Chronic Obstructive Lung Disease (GOLD) 1, 2, 3, and 4 classes, respectively. Patients with higher GOLD classes had higher number of hospital admissions, longer hospital stay, increased usage of noninvasive mechanical ventilation (NIV), combinations of long-acting bronchodilators, and higher mortality. Of the 9,776 subjects, 2,278 (23.3%) received NIV, but invasive mechanical ventilation was uncommon (134 of 9,776 subjects [1.4%]); 4,427 (45.3%) subjects had died by the end of 2014. The top causes of death were COPD, pneumonia, lung cancer, and other malignancies.

Conclusion

Patients admitted to hospitals for COPD in HK had significant comorbidities, mortality, and imposed heavy burden on health care resources. It is possible to collect and analyze data of a large COPD cohort through a computerized system. Suboptimal coding of lung function results was observed, and underutilization of long-acting bronchodilators was common.

Keywords:

• noninvasive ventilation
• medications
• chronic effect of TB
• GOLD classification
• health care resources

Supplementary material

List of hospitals included in the study

General hospitals

Alice Ho Miu Ling Nethersole Hospital, Caritas Medical Centre, Kwong Wah Hospital, North District Hospital, Pamela Youde Nethersole Eastern Hospital, Queen Elizabeth Hospital, Queen Mary Hospital, Prince of Wales Hospital, Princess Margaret Hospital, the Ruttonjee and Tang Shiu Kin Hospital, Tseung Kwan O Hospital, Tuen Mun Hospital, and United Christian Hospital.

Chest hospitals

Grantham Hospital, Haven of Hope Hospital, and Kowloon Hospital.

Acknowledgments

We would like to thank Ms Carrie Wong and Ms Reling Tse of Medial Records Office for generating the patient statistics from CDARS and Dr YL Cheng for his assistance in statistical analysis. We would also like to thank Dr Thomas Mok, Dr KS Lau, Dr KL Choo, Dr KK Chan, Dr CH Chau, Dr CM Chu, Dr ML Wong, Dr Wilson KS Yee, and Dr PY Tse who worked as coordinators for the hospitals involved in this study and the HK Lung Foundation for sponsoring this project.

Disclosure

The authors received no personal fee from any grant or commercial companies and report no other conflicts of interest in this work.