Costs of chronic obstructive pulmonary disease in urban areas of China: a cross-sectional study in four cities

Figures & data

Table 1 Demographic and clinical characteristics of COPD patients

	Male, n (%)	Female, n (%)	Total, n (%)
City
Beijing	100 (20.2)	70 (38.0)	170 (25.1)
Guangzhou	152 (30.8)	23 (12.5)	175 (25.8)
Shanghai	125 (25.3)	43 (23.4)	168 (24.8)
Chengdu	117 (23.7)	48 (26.1)	165 (24.3)
Age (>60 years)	417 (85.3)	140 (76.5)	557 (82.9)
Education (years)
≤9	290 (58.7)	127 (69.4)	417 (61.6)
10–12	122 (24.7)	42 (23.0)	164 (24.2)
>12	82 (16.6)	14 (7.7)	96 (14.2)
Monthly household income per capita, RMB Yuan (US$)
<1,000 (154)	30 (6.1)	9 (4.9)	39 (5.8)
1,000–1,999 (154–308)	132 (26.9)	65 (35.5)	197 (29.3)
2,000–2,999 (309–463)	152 (31.0)	59 (32.2)	211 (31.4)
3,000–3,999 (464–618)	74 (15.1)	20 (10.9)	94 (14.0)
≥4,000 (619)	102 (20.8)	30 (16.4)	132 (19.6)
Retired	418 (85.1)	155 (85.6)	573 (85.3)
Married	435 (88.2)	137 (74.5)	572 (84.5)
Current smoker	119 (24.1)	12 (6.5)	131 (19.4)
Regular exercise	232 (47.5)	61 (33.5)	293 (43.7)
Having medical insurance	471 (95.3)	177 (96.2)	648 (95.6)
Course of COPD(years)*	4.0 (8.9±12.0)	4.0 (9.1±10.7)	4.0 (8.9±11.6)
Comorbidities
0	123 (24.9)	19 (10.4)	142 (21.0)
1	172 (34.8)	61 (33.3)	233 (34.4)
2	124 (25.1)	46 (25.1)	170 (25.1)
≥3	75 (15.2)	57 (31.1)	132 (19.5)
Severity of COPD
Mild	88 (17.8)	52 (28.3)	140 (20.6)
Moderate	215 (43.5)	81 (44.0)	296 (43.7)
Severe	139 (28.1)	42 (22.8)	181 (26.7)
Very severe	52 (10.5)	9 (4.9)	61 (9.0)
Total	494 (72.9)	184 (27.1)	678 (100.0)

Note:

* Data were presented as median (mean ± standard deviation).

Abbreviation: COPD, chronic obstructive pulmonary disease.

Table 2 Annual direct and indirect costs per patient for COPD, RMB Yuan (US$)

	Beijing	Guangzhou	Shanghai	Chengdu	Total
Direct costs	7,870 (16,462±28,746)	3,773 (12,739±28,068)	6,288 (11,254±15,355)	7,071 (9,897±14,462)	6,096 (12,614±22,892)
	(1,218 [2,549±4,451])	(584 [1,972±4,346])	(974 [1,742±2,377])	(1,095 [1,532±2,239])	(944 [1,953±3,544])
Direct medical costs	6,824 (15,519±28,396)	3,178 (12,451±27,501)	5,214 (10,235±14,628)	6,628 (9,571±14,376)	5,565 (11,968±22,422)
	(1,057 [2,403±4,396])	(492 [1,928±4,258])	(807 [1,585±2,265])	(1,026 [1,482±2,226])	(862 [1,853±3,472])
Outpatient costs	2,939 (6,480±15,748)	1,328 (2,856±3,630)	2,598 (4,670±8,339)	0 (854±3,456)	1,278 (3,730±9,481)
	(455 [1,003±2,438])	(206 [442±562])	(402 [723±1,291])	(0 [132±535])	(198 [578±1,468])
Outpatient costs per visit	434 (598±901)	190 (278±377)	212 (298±300)	0 (97±343)	156 (319±567)
	(67 [93±139])	(29 [43±58])	(33 [46±46])	(0 [15±53])	(24 [49±88])
Hospitalization costs	0 (9,039±24,197)	0 (9,649±27,611)	0 (5,565±12,429)	6,397 (8,717±13,803)	0 (8,255±20,967)
	(0 [1,399±3,746])	(0 [1,494±4,275])	(0 [862±1,924])	(990 [1,350±2,137])	(0 [1,278±3,246])
Hospitalization costs per visit	0 (6,120±17,754)	0 (3,938±8,317)	0 (3,171±5,644)	3,695 (5,001±7,824)	0 (4,554±10,972)
	(0 [948±2,749])	(0 [610±1,288])	(0 [491±874])	(572 [774±1,211])	(0 [705±1,699])
Direct nonmedical costs	30 (680±1,378)	0 (308±1061)	0 (848±3,691)	0 (334±1,011)	0 (539±2,092)
	(5 [105±213])	(0 [48±164])	(0 [131±571])	(0 [52±157])	(0 [83±324])
Nutrition costs	0 (279±561)	0 (233±781)	0 (719±3,687)	0 (142±541)	0 (341±1,914)
	(0 [43±87])	(0 [36±121])	(0 [111±571])	(0 [22±84])	(0 [53±296])
Caregiver costs	0 (335±984)	0 (59±458)	0 (85±306)	0 (188±856)	0 (166±718)
	(0 [52±152])	(0 [9±71])	(0 [13±47])	(0 [29±133])	(0 [26±111])
Transportation costs	1 (67±114)	0 (16±140)	0 (44±85)	0 (5±22)	0 (33±104)
	(0 [10±18])	(0 [2±22])	(0 [7±13])	(0 [1±3])	(0 [5±16])
Indirect costs	0 (5,737±12,532)	0 (558±3,135)	0 (1,456±8,436)	0 (614±3,058)	0 (2,087±8,110)
	(0 [888±1,940])	(0 [86±485])	(0 [225±1,306])	(0 [95±473])	(0 [323±1,256])
Due to patient	0 (2,191±6,228)	0 (52±557)	0 (882±7,958)	0 (275±2,647)	0 (843±5,240)
	(0 [339±964])	(0 [8±86])	(0 [137±1,232])	(0 [43±410])	(0 [131±811])
Work loss, days	0 (8.4±6.0)	0 (0.3±0.9)	0 (3.3±7.5)	0 (2.1±5.1)	0 (3.5±5.4)
	(0 [8.4±6.0])	(0 [0.3±0.9])	(0 [3.3±7.5])	(0 [2.1±5.1])	(0 [3.5±5.4])
Due to family	0 (3,567±9,739)	0 (506±2,998)	0 (578±2,984)	0 (339±1,591)	0 (1,247±5,522)
	(0 [552±1,508])	(0 [78±464])	(0 [89±462])	(0 [52±246])	(0 [193±855])
Work loss, days	0 (13.7±9.3)	0 (3.1±4.6)	0 (2.2±2.8)	0 (2.6±3.1)	0 (5.4±5.7)
	(0 [13.7±9.3])	(0 [3.1±4.6])	(0 [2.2±2.8])	(0 [2.6±3.1])	(0 [5.4±5.7])
Total	11,038 (22,199±35,174)	3,773 (13,277±28,759)	6,473 (12,676±17,623)	7,200 (10,510±14,934)	6,405 (14,695±25,942)
	(1,709 [3,437±5,446])	(584 [2,056±4,453])	(1,002 [1,963±2,729])	(1,115 [1,627±2,312])	(992 [2,275±4,017])

Notes: Data were presented as median (mean ± standard deviation). Kruskal–Wallis or Wilcoxon test was used to test the differences of costs among groups.

Abbreviation: COPD, chronic obstructive pulmonary disease.

Figure 1 The proportion of the component of chronic obstructive pulmonary disease-related costs.

Note: The costs were the summary of 678 patients.

Table 3 Costs of COPD by demographic category, RMB Yuan (US$)

	Outpatient cost per visit	Hospitalization cost per visit	DMC	DNMC	IC	Total cost
City
Beijing	434 (598±901)	0 (6,120±17,755)	6,824 (15,519±28,396)	30 (680±1,378)	0 (5,737±12,532)	11,038 (22,199±35,174)
	(67 [93±139])	(0 [947±2,749])	(1,057 [2,403±4,396])	(5 [105±213])	(0 [888±1,940])	(1,709 [3,437±5,446])
Guangzhou	190 (278±377)	0 (3,938±8,318)	3,178 (12,451±27,501)	0 (308±1,062)	0 (558±3,135)	3,773 (13,277±28,759)
	(29 [43±58])	(0 [610±1,288])	(492 [1,928±4,258])	(0 [48±164])	(0 [86±485])	(584 [2,056±4,453])
Shanghai	212 (298±300)	0 (3,171±5,644)	5,214 (10,236±14,628)	0 (848±3,691)	0 (1,456±8,436)	6,473 (12,676±17,623)
	(33 [46±46])	(0 [491±874])	(807 [1,585±2,265])	(0 [131±571])	(0 [225±1,306])	(1,002 [1,963±2,728])
Chengdu	0 (97±343)	3,695 (5,001±7,824)	6,628 (9,571±14,376)	0 (334±1,011)	0 (614±3,058)	7,200 (10,510±14,934)
	(0 [15±53])	(572 [774±1,211])	(1,026 [1,482±2,226])	(0 [52±157])	(0 [95±473])	(1,115 [1,627±2,312])
P-value	<0.001	<0.001	0.012	<0.001	<0.001	<0.001
Sex
Male	156 (304±556)	0 (4,494±11,635)	5,977 (11,963±23,020)	0 (534±2,330)	0 (1,529±6,944)	6,397 (14,123±25,051)
	(24 [47±86])	(0 [696±1,801])	(925 [1,852±3,564])	(0 [83±361])	(0 [237±1,075])	(990 [2,187±3,879])
Female	164 (360±596)	0 (4,715±8,980)	4,712 (11,982±20,804)	8 (554±1,257)	0 (3,583±10,505)	6,413 (16,223±28,199)
	(25 [56±92])	(0 [730±1,390])	(730 [1,855±3,221])	(1 [86±195])	(0 [555±1,627])	(993 [2,512±4,366])
P-value	0.67	0.704	0.71	0.004	<0.001	0.726
Age (years)
≤60	257 (351±405)	0 (1,429±3,483)	3736 (5592±6583)	0 (121±269)	0 (3,091±11,189)	3,850 (8,804±14,253)
	(40 [54±63])	(0 [221±539])	(578 [866±1,019])	(0 [19±42])	(0 [479±1,732])	(596 [1,363±2,207])
>60	144 (314±598)	0 (5,165±11,806)	6,096 (13,083±23,564)	0 (626±2,296)	0 (1,726±6,194)	7,071 (15,580±25,846)
	(22 [49±93])	(0 [800±1,828])	(944 [2,026±3,648])	(0 [97±356])	(0 [267±959])	(1,095 [2,412±4,002])
P-value	0.006	<0.001	0.003	0.094	0.204	0.006
Household income per capita monthly, RMB Yuan (US≥)
<1,000 (154)	100 (280±430)	0 (5,562±9,291)	7,128 (13,482±19,810)	6 (357±959)	0 (3,278±9,036)	7,533 (17,368±26,818)
	(15 [43±67])	(0 [861±1,439])	(1,104 [2,087±3,067])	(1 [55±149])	(0 [508±1,399])	(1,166 [2,689±4,152])
1,000–1,999 (154–308)	46 (241±455)	2862 (4,351±5,394)	6,993 (10,816±14,315)	0 (404±990)	0 (2,009±8,801)	7,666 (13,220±17,873)
	(7 [37±70])	(443 [674±835])	(1083 [1,675±2,216])	(0 [63±153])	(0 [311±1,363])	(1,187 [2,047±2,767])
2,000–2,999 (309–463)	179 (363±733)	0 (4,120±7,560)	5,429 (12,676±23,824)	0 (704±3,081)	0 (2,446±9,346)	6,825 (15,953±28,895)
	(28 [56±114])	(0 [638±1,171])	(841 [1,963±3,689])	(0 [109±477])	(0 [379±1,447])	(1,057 [2,470±4,474])
3,000–3,999 (464–618)	198 (341±484)	0 (4,522±10,111)	4,532 (12,038±28,767)	0 (487±1,442)	0 (2,539±7,358)	5,412 (15,173±30,497)
	(31 [53±75])	(0 [700±1565])	(702 [1,864±4,454])	(0 [75±223])	(0 [393±1,139])	(838 [2,349±4,722])
≥4,000 (619)	232 (372±503)	0 (5,076±19,386)	3,348 (11,455±23,636)	0 (594±2,053)	0 (1,041±4,493)	3,756 (13,276±25,901)
	(36 [58±78])	(0 [786±3,001])	(518 [1,774±3,660])	(0 [92±318])	(0 [161±696])	(582 [2,056±4,010])
P-value	<0.001	0.003	0.54	0.549	0.464	0.632
Having medical insurance
Yes	157 (322±575)	0 (4,576±11,097)	5,750 (12,112±22,706)	0 (553±2,133)	0 (2,105±8,234)	6,534 (14,889±26,309)
	(24 [50±89])	(0 [709±1,718])	(890 [1,875±3,515])	(0 [86±330])	(0 [326±1,275])	(1,012 [2,305±4,073])
No	148 (263±360)	0 (4,062±7,947)	2,954 (8758±14,656)	0 (247±754)	0 (1,688±4,857)	2,954 (10,447±15,603)
	(23 [41±56])	(0 [629±1,230])	(457 [1,356±2,269])	(0 [38±117])	(0 [261±752])	(457 [1,618±2,416])
P-value	0.535	0.445	0.176	0.14	0.953	0.183
Current severity of COPD
Mild	122 (195±281)	0 (1,908±5,401)	2,288 (5,141±12,953)	0 (589±2,718)	0 (1,107±4,076)	2,857 (6,837±14,710)
	(19 [30±43])	(0 [295±836])	(354 [796±2,006])	(0 [91±421])	(0 [171±631])	(442 [1,059±2,278])
Moderate	171 (325±487)	0 (4,463±14,380)	4,257 (10,280±19,986)	0 (525±2,329)	0 (2,629±9,055)	4,870 (13,553±26,173)
	(26 [50±75])	(0 [691±2226])	(659 [1,592±3,094])	(0 [81±361])	(0 [407±1,402])	(754 [2,098±4,052])
Severe	161 (339±493)	0 (5,712±7,814)	8,408 (15,802±25,838)	10 (527±1,233)	0 (2,346±9,844)	10,350 (18,875±28,178)
	(25 [52±76])	(0 [884±1,210])	(1,302 [2,447±4,000])	(2 [82±191])	(0 [363±1,524])	(1,602 [2,922±4,363])
Very severe	227 (518±1215)	6,516 (7,628±7,816)	1,1316 (2,4941±31,692)	0 (531±998)	0 (1,014±2,913)	12,359 (26,377±32,059)
	(35 [80±188])	(1,009 [1,181±1,210])	(1,752 [3,862±4,907])	(0 [82±154])	(0 [157±451])	(1,913 [4,084±4,964])
P-value	0.026	<0.001	<0.001	0.002	0.75	<0.001
Number of comorbidities
0	184 (309±418)	0 (3,551±18,202)	2,977 (7,693±19,428)	0 (548±3,577)	0 (1,311±8,768)	3,048 (9,503±22,543)
	(28 [48±65])	(0 [550±2,818])	(461 [1,191±3,008])	(0 [85±554])	(0 [203±1,357])	(472 [1,471±3,490])
1	146 (205±272)	0 (3,986±6,470)	4,874 (10,138±17,466)	0 (397±1,582)	0 (918±4,305)	5,412 (11,487±19,427)
	(23 [32±42])	(0 [617±1,002])	(755 [1,570±2,704])	(0 [62±245])	(0 [142±666])	(838 [1,779±3,008])
2	106 (362±837)	0 (4,992±9,451)	6,198 (13,513±23,177)	0 (526±1,278)	0 (1,695±4,815)	7,679 (16,014±24,356)
	(16 [56±130])	(0 [773±1,463])	(960 [2,092±3,589])	(0 [81±198])	(0 [262±745])	(1,189 [2,479±3,771])
≥3	255 (476±625)	2,765 (6,103±8,471)	9,222 (17,803±29,847)	40 (803±1,477)	0 (5,506±13,383)	13,192 (24,263±36,730)
	(39 [74±97])	(428 [945±1,312])	(1,428 [2,756±4,621])	(6 [124±229])	(0 [852±2,072])	(2,043 [3,757±5,687])
P-value	0.002	<0.001	<0.001	<0.001	<0.001	<0.001

Notes: Data were presented as median (mean ± standard deviation). Kruskal–Wallis or Wilcoxon test was to test the differences of costs among groups. Values in bold indicated statistical significance.

Abbreviations: COPD, chronic obstructive pulmonary disease; DMC, direct medical cost; DNMC, direct nonmedical cost; IC, indirect cost.

Table 4 Factors related to total costs due to COPD

Factors	Low burden, n	High burden, n	cOR (95% CI)	P-value	aOR (95% CI)a	P-valuea
Sex
Female	128	53	1		1
Male	370	113	0.74 (0.50, 1.08)	0.12	0.76 (0.46, 1.25)	0.284
Age (years)
≤60	102	13	1		1
>60	391	152	3.05 (1.66, 5.60)	<0.001	2.36 (1.18, 4.72)	0.015
Education (years)
≤9	290	114	1.94 (1.09, 3.46)	0.025	1.45 (0.72, 2.93)	0.294
10–12	128	36	1.39 (0.72, 2.67)	0.324	1.46 (0.68, 3.15)	0.334
>12	79	16	1		1
Duration of disease in years	3.00 (8.72±11.86)b	5.00 (9.74±11.12)b	1.01 (0.99, 1.02)	0.334	0.99 (0.97, 1.00)	0.136
Having medical insurance
Yes	476	159	1 (0.42, 2.40)	0.996	0.60 (0.20, 1.86)	0.378
No	21	7	1		1
Number of comorbidities
0	122	18	1		1
1	184	43	1.58 (0.87, 2.87)	0.13	1.06 (0.51, 2.19)	0.873
2	115	51	3.01 (1.66, 5.45)	<0.001	1.87 (0.88, 3.96)	0.104
≥3	76	54	4.82 (2.63, 8.82)	<0.001	2.05 (0.93, 4.54)	0.076
Monthly family per capita income, RMB Yuan (US≥)
<1,000 (154)	26	12	1		1
1,000–1,999 (154–308)	144	50	0.75 (0.35, 1.60)	0.461	0.72 (0.28, 1.88)	0.503
2,000–2,999 (309–463)	154	51	0.72 (0.34, 1.53)	0.388	0.76 (0.29, 2.01)	0.586
3,000–3,999 (464–618)	69	24	0.75 (0.33, 1.72)	0.503	0.79 (0.28, 2.24)	0.660
≥4,000 (619)	101	28	0.6 (0.27, 1.34)	0.213	0.66 (0.23, 1.86)	0.427
Current disease severity
Mild	126	12	1		1
Moderate	219	64	3.07 (1.60, 5.90)	0.001	3.26 (1.55, 6.87)	0.002
Severe	110	64	6.11 (3.13, 11.91)	<0.001	4.17 (1.91, 9.09)	<0.001
Very severe	35	24	7.2 (3.28, 15.83)	<0.001	4.43 (1.76, 11.13)	0.002
Exacerbations
No	437	47	1		1
Yes	94	68	6.73 (4.36, 10.38)	<0.001	4.68 (2.71, 8.08)	<0.001
Number of exacerbations	1.00 (1.17±1.76)	2.00 (2.41±2.01)	1.38 (1.25, 1.52)	<0.001	1.27 (1.13, 1.43)	<0.001

Notes:

a Adjusted for city and other variables.

b Data shown as median (mean ± standard deviation). Values in bold indicated significance, P<0.05.

Abbreviations: CI, confidence interval; COPD, chronic obstructive pulmonary disease; cOR, crude odds ratio; aOR, adjusted odds ratio.