Trends in Hospitalization Expenditures for Acute Exacerbations of COPD in Beijing from 2009 to 2017

Figures & data

Table 1 Characteristics of Admissions for Acute Exacerbations of Chronic Obstructive Pulmonary Disease (AECOPD) in Beijing from 2009 to 2017

	2009	2010	2011	2012	2013	2014	2015	2016	2017	P
Number	25,433	29,163	30,151	35,825	40,423	45,442	34,844	37,179	36,656	<0.001^c
Gender, n (%)
Male	14,946	17,235	17,838	21,794	25,130	29,567	23,170	25,279	25,214	<0.001^d
	58.8%	59.1%	59.2%	60.8%	62.2%	65.1%	66.5%	68.0%	68.8%
Female	10,487	11,928	12,313	14,031	15,293	15,875	11,674	11,900	11,442
	41.2%	40.9%	40.8%	39.2%	37.8%	34.9%	33.5%	32.0%	31.2%
Age, n (%)
18~39 yrs	340	366	345	392	414	405	361	438	404	0.003^e
	1.3%	1.3%	1.1%	1.1%	1.0%	0.9%	1.0%	1.20%	1.1%
40~59 yrs	2,247	2,351	2,413	3,010	3,734	4,470	3,091	2,961	2,800
	8.8%	8.1%	8.0%	8.4%	9.2%	9.8%	8.9%	8.0%	7.6%
60~69 yrs	3,696	4,057	4,184	5,197	6,294	8,071	6,760	7,736	7,969
	14.5%	13.9%	13.9%	14.5%	15.6%	17.8%	19.4%	20.8%	21.7%
70~79 yrs	10,897	11,923	11,761	13,262	13,684	14,331	10,566	10,940	10,355
	42.8%	40.9%	39.0%	37.0%	33.9%	31.5%	30.3%	29.4%	28.2%
≥80 yrs	8,253	10,466	11,448	13,964	16,297	18,165	14,066	15,104	15,128
	32.4%	35.9%	38.0%	39.0%	40.3%	40.0%	40.4%	40.6%	41.3%
Disease type,^a n (%)
Emphysema	228	220	134	152	153	139	115	147	154	<0.001^e
	0.9%	0.8%	0.4%	0.4%	0.4%	0.3%	0.3%	0.4%	0.4%
Bull^a	274	329	324	361	370	383	401	417	380
	1.1%	1.1%	1.1%	1.0%	0.9%	0.8%	1.2%	1.1%	1.0%
Bronchitis	7,523	8,023	7,605	8,378	8,753	10,966	5,475	5,555	5,062
	29.6%	27.5%	25.2%	23.4%	21.7%	24.1%	15.7%	14.9%	13.8%
COPD	17,408	20,591	22,088	26,934	31,147	33,954	28,853	31,060	31,060
	68.4%	70.6%	73.3%	75.2%	77.1%	74.7%	82.8%	83.5%	84.7%
Hospital level, n (%)
Level 2 (secondary)	7,396	8,739	9,214	11,157	12,326	14,135	10,521	11,117	10,708	0.324^d
	29.1%	30.0%	30.6%	31.1%	30.5%	31.1%	30.2%	29.9%	29.2%
Level 3 (tertiary)	18,037	20,424	20,937	24,668	28,097	31,307	24,323	26,062	25,948
	70.9%	70.0%	69.4%	68.9%	69.5%	68.9%	69.8%	70.1%	70.8%
Mean of LOS (days)	16.0	15.9	15.4	14.5	14.1	14.3	14.0	13.8	13.5	<0.001^f
Proportion of drug cost^b (%)	52.9%	52.3%	48.8%	48.1%	47.2%	46.7%	45.5%	45.8%	39.4%	<0.001^g

Notes: ^aDisease types: All patients with AECOPD were subdivided into four types according to ICD-10 codes for AECOPD. ^bDrug cost includes costs for Western medicine and Chinese traditional medicine. ^cP-value for time trend estimated using Poisson regression. ^dP-value for time trend estimated using logistic regression. ^eP-value for time trend estimated using multinomial logit regression. ^fP-value of the Kruskal–Wallis test comparing LOS in different year groups. ^gP-value for time trend estimated using linear regression.

Abbreviations: COPD, chronic obstructive pulmonary disease; LOS: length of stay.

Table 2 Hospitalization Costs (CNY) per Admission for Patients with Acute Exacerbations of Chronic Obstructive Pulmonary Disease (AECOPD) in Beijing (2009–2017, n = 315,116)

Year	N	Mean	Median	P25	P75	P99	SD	P^a
2009	25,433	19,760	13,046	8,146	21,526	126,462	31,399	0.697
2010	29,163	21,220	13,812	8,820	22,326	141,207	40,993
2011	30,151	20,154	13,303	8,744	20,855	133,972	34,290
2012	35,825	19,835	13,561	8,974	21,183	127,197	29,743
2013	40,423	19,684	13,833	9,386	21,546	109,310	27,706
2014	45,442	19,935	13,964	9,715	21,447	114,761	27,190
2015	34,844	20,571	14,908	10,300	22,615	109,336	24,365
2016	37,179	20,567	14,995	10,498	23,256	104,092	22,816
2017	36,656	20,118	14,843	10,526	22,632	101,666	21,550

Notes: ^aP-value for time trend estimated using linear regression. All costs shown are adjusted for the increment of inflation in 2017.

Abbreviations: CNY, Chinese yuan; P25, 25th percentile; P50, 50th percentile; P75, 75th percentile; P99, 99th percentile; SD, standard deviation.

Table 3 Hospitalization Costs (CNY) per Capita for Patients with Acute Exacerbations of Chronic Obstructive Pulmonary Disease (AECOPD) in Beijing (2009–2017)

Year	N	Mean	Median	P25	P75	P99	SD	P^a
2009	21,190	23,716	13,589	8,225	24,420	17,5770	40,942	<0.001
2010	23,652	26,165	14,565	8,983	26,052	19,6495	53,238
2011	23,863	25,464	14,199	8,966	25,125	20,8785	50,617
2012	27,301	26,028	14,638	9,307	25,761	19,9303	49,470
2013	28,642	27,780	15,335	9,749	27,375	20,8753	55,251
2014	30,411	29,788	16,384	10,237	29,524	21,9803	56,879
2015	23,257	30,820	16,905	10,435	30,892	23,6891	51,010
2016	24,588	31,099	17,587	10,905	31,616	22,5724	49,140
2017	23,788	31,000	17,542	11,106	31,424	21,7764	49,695

Notes: ^aP-value for time trend estimated using linear regression. CNY: Chinese yuan. All costs shown are adjusted for the increment of inflation in 2017.

Abbreviations: P25, 25th percentile; P50, 50th percentile; P75, 75th percentile; P99, 99th percentile; SD, standard deviation.

Table 4 Contribution of Increased per Admission Expenditures and Number of Admissions to Increased per Capita Expenditures Based on Their Annual Growth Rate for AECOPD Hospitalizations in Beijing (2009–2017)

	Per capita Expenditures	Number of Admissions	Per admission Expenditures
Annual growth rate (%)	1.7	1.6	0.1
Contribution^a (%)	–	93.5	6.5

Notes: ^aContributions were calculated by the annual growth rate of per admission expenditures or the number of admissions divided by the annual growth rate of per admission expenditures × 100%.

Abbreviation: AECOPD, acute exacerbation of chronic obstructive pulmonary disease.

Figure 1 Annual average number of admissions per capita.

Figure 2 Distribution of the number of admissions per person per year.

Figure 3 Expenditures per admission from 2009 to 2017. (A) Gender-specific expenditures per admission. (B) Age-specific expenditures per admission. (C) Disease type–specific expenditures per admission. (D) Hospital level–specific expenditures per admission.

Figure 4 Annual expenditures per capita from 2009 to 2017. (A) Gender-specific annual expenditures per capita. (B) Age-specific annual expenditures per capita. (C) Disease type–specific annual expenditures per capita. (D) Hospital level–specific annual expenditures per capita.

Table 5 Contributing Factors to per Admission Expenditures and per Capita Expenditures for AECOPD Hospitalizations in Beijing (2009–2017)

Factor	Per admission Expenditures (× 1000 CNY)		Per capita Expenditures (× 1000 CNY)
	β (95% CI)	P	β (95% CI)	P
Gender (female = 0)	0.203 (0.026, 0.381)	0.025	1.048 (0.718, 1.378)	<0.001
Hospital level (level 2 = 0)
Level 3	5.218 (5.034, 5.402)	<0.001	7.195 (6.847, 7.544)	<0.001
Age, years (18~30 = 0)
40~59	−1.060 (2.042, −0.077)	0.025	−1.593 (−3.212, 0.027)	0.054
60~69	−0.875 (−1.854, 0.105)	0.080	−1.422 (−3.038, 0.195)	0.085
70~79	2.477 (1.505, 3.449)	<0.001	2.951 (1.351, 4.550)	<0.001
≥ 80	5.760 (4.788, 6.731)	<0.001	8.090 (6.491, 9.689)	<0.001
Disease type (bronchitis = 0)
COPD	2.559 (2.349, 2.768)	<0.001	2.692 (2.311, 3.074)	<0.001
Emphysema	9.140 (7.849, 10.430)	<0.001	9.198 (7.044, 11.352)	<0.001
Bulla	18.641 (17.654, 19.629)	<0.001	18.496 (16.861, 20.130)	<0.001
Length of stay (days)	1.008 (1.002, 1.014)	<0.001	1.084 (1.074, 1.094)	<0.001
Number of admissions			20.29 (20.165, 20.414)	<0.001

Notes: Adjusted for year fixed effects in the multivariable linear regression model.

Abbreviations: AECOPD, acute exacerbation of chronic obstructive pulmonary disease; CI, confidence interval; CNY, Chinese yuan.