Long-Term Trends in Hospitalization and Outcomes in Adult Patients with Exacerbation of Chronic Obstructive Pulmonary Disease in Beijing, China, from 2008 to 2017

Figures & data

Table 1 Hospitalization Rates^a Among Patients Hospitalized for Acute Exacerbations of Chronic Obstructive Pulmonary Disease, 2008–2017

	2008	2009	2010	2011	2012	2013	2014	2015	2016	2017	P
Number	23194	25341	29492	29870	36539	40315	45681	34491	37403	35476	0.227^b
In 100,000 habitants	150.15	155.09	172.40	165.02	191.55	200.87	218.74	159.03	167.59	161.13
Gender											<0.001^c
Women	131.86	133.97	147.40	139.78	155.18	156.47	153.52	106.39	106.19	98.91
Men	166.90	174.30	195.19	187.91	224.74	241.67	279.40	208.02	225.04	221.23
Age, Years											<0.001^c
20–39	8.92	7.43	8.04	8.46	9.31	10.00	8.94	8.64	10.66	10.15
40–59	49.59	50.71	52.47	52.32	65.87	78.31	94.39	64.67	65.91	58.68
60–79	687.99	726.66	790.13	741.65	860.85	886.51	975.33	725.30	770.75	726.35
≥80	2252.33	2273.00	2734.15	2659.42	3002.08	3079.30	3161.54	2198.06	2269.74	2381.07
Hospital Level											<0.001^c
Secondary hospitals	45.03	45.39	51.60	50.23	59.52	60.07	67.18	47.18	49.80	46.60
Tertiary hospitals	105.11	109.70	120.81	114.79	132.03	140.80	151.57	111.84	117.78	114.53

Notes: ^aHospitalization rates were calculated by dividing the number of cases per year for the relevant sex/age group by the corresponding number of persons in that population group, age-adjusted based on the 2010 population census. ^bP value for time trend of hospitalization rates estimated using Poisson regression models. ^cP value for subgroup comparisons estimated using Poisson regression models, with adjustment for year.

Figure 1 Hospitalization rates among patients hospitalized with acute exacerbations of chronic obstructive pulmonary disease (AECOPD) by gender, age, and hospital type from 2008 to 2017 in Beijing, China. Data presented as annual hospitalization rates calculated by dividing the total number of hospitalizations for AECOPD in a year by the corresponding number of inhabitants in that population group according to the Beijing Municipal Bureau of Statistics. (A) Overall and gender-specific hospitalization rates. (B) Age-specific hospitalization rates. (C) Hospital type-specific hospitalization rates.

Table 2 In-Hospital Mortality^a Among Patients Hospitalized for Acute Exacerbations of Chronic Obstructive Pulmonary Disease, 2008–2017

	2008	2009	2010	2011	2012	2013	2014	2015	2016	2017	P
Number	907	884	1147	962	1150	1252	1316	832	899	785	<0.001^b
IHM	3.91	3.49	3.89	3.22	3.15	3.11	2.88	2.41	2.40	2.21
Gender											<0.001^c
Women	3.80	3.71	4.06	3.17	3.10	3.36	3.36	2.87	2.73	2.59
Men	3.99	3.33	3.77	3.26	3.18	2.95	2.63	2.18	2.25	2.04
Age, Years											<0.001^c
20~39	0.00	0.00	0.00	0.29	0.00	0.00	0.00	0.00	0.00	0.00
40~59	0.97	0.73	1.13	0.87	0.49	0.63	0.29	0.49	0.34	0.28
60~79	2.93	2.47	2.87	2.01	2.02	2.06	1.72	1.37	1.25	1.13
≥80	6.97	6.40	6.38	5.66	5.49	5.19	5.17	4.33	4.45	4.07
Hospital Level											<0.001^c
Secondary hospitals	4.06	2.92	3.67	2.76	2.95	2.90	2.92	2.45	2.15	2.10
Tertiary hospitals	3.85	3.72	3.98	3.42	3.24	3.20	2.86	2.39	2.51	2.26

Notes: aIn-hospital mortality was calculated by dividing the number of deaths among hospitalized subjects in the relevant sex/age group by the corresponding number of persons in that population group according to the Bureau of Statistics of China’s 2010 data. ^bP value for time trend of IHM estimated using logistic regression models. ^cP value for subgroup comparisons estimated using logistic regression models, with adjustment for year.

Figure 2 In-hospital mortality among patients hospitalized acute exacerbations of chronic obstructive pulmonary disease from 2008 to 2017 in Beijing, China. (A) Overall and gender-specific in-hospital mortality. (B) Age-specific in-hospital mortality. (C) Hospital type-specific in-hospital mortality.

Table 3 Trend Analysis of Hospitalization Rates and in-Hospital Mortality for Acute Exacerbations of Chronic Obstructive Pulmonary Disease (AECOPD) by Age, Sex, and Hospital Type, 2008–2017

	Rate (95% CI)^a		Rate Difference (95% CI)	Overall Trend		Trend Segment1^b			Trend Segment2
	2008	2017		AAPC (95% CI)	P	Period	APC (95% CI)	P	Period	APC (95% CI)	P
Incidence
Total	150.1 (143.4, 56.9)	161.1 (154.8, 167.5)	−11.0 (−11.4, −10.6)	0.2 (−2.0, 2.5)	0.865	2008–2014	5.5 (2.9, 8.2)	0.003	2014–2017	−9.7 (−16.0, −2.9)	0.015
Sex
Women	131.9 (123.0, 41.0)	98.9 (92.2, 106.0)	32.9 (30.8, 35.0)	−3.6 (−7.7, 0.7)	0.099	2008–2013	3.9 (−2.9, 11.3)	0.206	2013–2017	−12.3 (−20.3, −3.4)	0.017
Men	166.9 (156.9, 77.0)	221.2 (210.7, 231.8)	−54.3 (−53.8, −54.8)	2.9 (0.4, 5.5)	0.022	2008–2014	8.0 (4.9, 11.1)	0.001	2014–2017	−6.5 (−13.5, 1.1)	0.078
Age Group
20–39	8.9 (7.1, 10.7)	10.1 (8.1, 12.2)	−1.2 (−1.5, −1.0)	2.6 (0.4, 4.8)	0.024	2008–2017	2.6 (0.4, 4.8)^c	0.024
40–59	49.6 (45.5, 53.6)	58.7 (54.5, 62.9)	−9.1 (−9.2, −9.0)	2.7 (−1.9, 7.6)	0.254	2008–2014	11.5 (5.8, 17.5)	0.003	2014–2017	−12.7 (−24.9, 1.5)	0.068
60–79	688.0 (665.4, 710.6)	726.3 (705.6, 747.1)	−38.4 (−40.2, −36.5)	0.1 (−2.4, 2.6)	0.952	2008–2014	4.8 (1.9, 7.8)	0.007	2014–2017	−8.8 (−15.8, −1.1)	0.033
≥80	2252.3 (2167.1, 337.6)	2381.1 (2316.4, 2445.8)	−128.7 (−149.3, −108.2)	−0.3 (−6.1, 5.7)	0.912	2008–2013	6.9 (−3.7, 18.6)	0.163	2013–2017	−8.6 (−18.7, 2.6)	0.102
Institute Level
Secondary hospitals	45.0 (41.4, 48.8)	46.6 (43.5, 49.9)	−1.6 (−2.1, −1.1)	−0.1 (−2.7, 2.5)	0.935	2008–2014	6.0 (3.0, 9.2)	0.004	2014–2017	−11.3 (−18.5, −3.6)	0.014
Tertiary hospitals	105.1 (99.5, 110.8)	114.5 (109.1, 120.0)	−9.4 (−9.6, −9.2)	0.3 (−1.9, 2.6)	0.778	2008–2014	5.3 (2.7, 7.9)	0.003	2014–2017	−8.9 (−15.3, −2.1)	0.021
In-Hospital Mortality
Total	1.1 (0.8, 1.6)	0.4 (0.2, 0.7)	0.7 (0.5, 0.9)	−11.4 (−15.5, −7.0)	<0.001	2008–2017	−11.4 (−15.5,-7.0)^c	<0.001
Sex
Women	1.1 (0.6, 1.9)	0.3 (0.1, 1.0)	0.8 (0.4, 0.9)	−13.1 (−16.6, −9.4)	<0.001	2008–2014	−7.0 (−9.8, −4.2)	0.002	2014–2017	−24.0 (−34.8, −11.4)	0.006
Men	1.1 (0.7, 1.8)	0.4 (0.2, 0.7)	0.7 (0.5, 1.1)	−12.3 (−18.9, −5.2)	0.005	2008–2017	−12.3 (−18.9, −5.2)^c	0.005
Age Group
20–59	0.8 (0.4, 1.4)	0.2 (0.0, 0.6)	0.6 (0.4, 0.8)	−13.2 (−21.5, −4.0)	0.012	2008–2017	−13.2 (−21.5, −4.0)^c	0.012
60–79	2.2 (1.7, 2.8)	0.9 (0.7, 1.2)	1.3 (1, 1.6)	−9.4 (−11.6, −7.1)	<0.001	2008–2017	−9.4 (−11.6, −7.1)^c	<0.001
≥80	6.8 (5.8, 8.0)	3.8 (3.3, 4.4)	3.0 (2.5, 3.6)	−6.2 (−7.1, −5.2)	<0.001	2008–2017	−6.2 (−7.1, −5.2)^c	<0.001
Hospital Level
Secondary hospitals	1.0 (0.5, 1.9)	0.4 (0.1, 1.0)	0.6 (0.3, 1.0)	−11.4 (−16.6, −6.0)	0.002	2008–2017	−11.4 (−16.6, −6.0)^c	0.002
Tertiary hospitals	1.2 (0.8, 1.8)	0.4 (0.2, 0.7)	0.8 (0.5, 1.0)	−11.1 (−16.9, −4.8)	0.004	2008–2017	−11.1 (−16.9, −4.8)^c	0.004

Notes: APC denotes annual percentage change; AAPC denotes average annual percent change. ^aPer 100,000 inhabitants for AECOPD hospitalization rates and per 100,000 inhabitants for AECOPD in-hospital mortality, age-adjusted based on the 2010 population census. ^bTrend segment identified by Joinpoint regression. ^cAPC = AAPC when trend had 0 Joinpoints.

Table 4 Use of Mechanical Ventilation, Length of Hospital Stay (LOHS), and Costs for Acute Exacerbations of Chronic Obstructive Pulmonary Disease, 2008–2017

	2008	2009	2010	2011	2012	2013	2014	2015	2016	2017	P
Mechanical Ventilation
N,%	——	——	——	——	2031 (16.33%)	2588 (20.81%)	2746 (22.08%)	1663 (13.37%)	1825 (14.68%)	1489 (11.97%)	<0.001^a
Average hours of receiving mechanical ventilation, hours
Mean	——	——	——	——	255.23	237.65	228.47	244.95	220.83	233.57	0.118^b
SD	——	——	——	——	435.35	443.97	333.56	309.20	273.13	273.96
Median	——	——	——	——	130	138	137	147	140	139
Q1–Q3	——	——	——	——	50–300	55–277	67–282	64–311	48–287	57–296
LOHS, Days
Mean	16.71	16.22	15.75	15.42	14.44	14.05	14.18	13.91	13.50	13.18	<0.001^b
SD	21.80	23.60	15.61	22.93	13.30	13.03	11.33	9.84	8.62	8.04
Median	13	13	13	12	12	12	12	12	12	12
Q1	9	9	9	8	8	8	8	8	8	8
Q3	19	18	18	17	17	17	17	17	16	16
Cost^d, CNY
Mean	15953.5	18483	19982.9	19205.1	18988	19163	19482	20012.5	20220.8	19874.5
SD	22542.2	30501.1	39812.5	33546.2	29203.9	27404.4	26977.3	24136.5	22693.4	21485.9
Median	10875.1	12120.9	13021.6	12747.1	13035.4	13544.9	13718.6	14615.1	14777.7	14698.4	<0.001^c
Q1	6378.3	7079.5	7815.3	7989.9	8262.8	8940.5	9366.5	9809.6	10194.2	10282.3
Q3	18064.8	20493.5	21494.1	20229.4	20572.1	21199.3	21137.8	22238	23044.1	22470.3

Notes: —— indicates that data were unavailable. ^aP value for time trend estimated using logistic regression models. ^bP value comparing medians over the study period calculated using the Kruskal–Wallis test. ^cP value for time trend estimated using simple linear regression analysis. ^dAll costs shown are adjusted for the increment of inflation in 2017.