Impact of Coexisting Dementia on Inpatient Outcomes for Patients Admitted with a COPD Exacerbation

Figures & data

Figure 1 Flow chart of patients included in the study.

Table 1 Baseline Characteristics for Patients Admitted with a COPD Exacerbation with and without Dementia

Variables		Total	Patients with Dementia	Patients without Dementia	p value
Number of patients [n (%)]		576,381	35,372 (6)	541,009 (94)
Age (years) [n (%)]	41–65	209,754 (36)	1505 (4)	208,249 (15)	p<0.001
	65–74	170,802 (30)	6074 (17)	164,728 (30)
	≥75	195,825 (34)	27,793 (79)	168,032 (31)
Gender [n (%)]	Female	325,409 (56)	21,086 (60)	304,323 (56)	p<0.001
	Male	250,972 (43)	14,286 (39)	236,686 (43)
Race [n (%)]	White	466,431 (81)	28,743 (81)	437,688 (81)	p<0.001
	Black	65,233 (11)	3054 (9)	62,179 (11)
	Hispanic	27,055 (5)	2265 (6)	24,790 (5)
	Asian/Pacific Islander	5599 (1.0)	479 (1.4)	5120 (1.0)
	Native American	2947 (0.5)	146 (0.4)	2801 (0.5)
	Other	9116 (1.6)	685 (1.9)	8431 (1.6)
Expected primary payer [n (%)]	Medicare	414,252 (72)	32,553 (92)	381,699 (71)	p<0.001
	Medicaid	64,410 (11)	831 (2)	63,579 (12)
	Private insurance	66,260 (12)	1493 (4)	64,767 (12)
	Self-pay	17,411 (3)	101 (0.3)	17,310 (3)
	No charge	2068 (0.4)	11 (0.03)	2057 (0.4)
	Other	11,980 (2)	383 (1)	11,597 (2)
Year of admission [n (%)]	2011	125,252 (22)	8202 (23)	117,050 (22)	p<0.001
	2012	119,699 (21)	7468 (21)	112,231 (21)
	2013	115,595 (20)	7090 (20)	108,505 (20)
	2014	106,813 (19)	6374 (18)	100,439 (19)
	2015	109,022 (19)	6238 (18)	102,784 (19)
Modified Charlson Comorbidity Index score [n (%)] ^†	0	227,217 (38)	11,000 (31)	216,217 (39)	p<0.001
	1	153,665 (27)	9694 (27)	143,971 (27)
	>2	195,499 (34)	14,678 (41)	180,821 (33)
Respiratory compromise [n (%)]	Yes	62,821 (10.9)	3741 (10.6)	59,080 (10.9)	0.04
	No	513,560 (89.1)	31,631 (89.4)	481,929 (89.1)
Receiving NIV if respiratory compromise [n (%)]	Yes	11,110 (18)	691 (18)	10,419 (18)	0.2
	No	51,711 (82)	3050 (82)	48,661 (82)
Receiving MV if respiratory compromise [n (%)]	Yes	16,606 (26)	1001 (27)	15,605 (26)	0.6
	No	46,215 (74)	2740 (73)	43,475 (74)

Note: ^†Excludes diagnoses of dementia and COPD.

Abbreviations: IQR, interquartile range; NIV, non-invasive ventilation; MV, echanical ventilation.

Table 2 Inpatient Deaths Stratified by Age for Patients with and without Dementia

Age (Years)	COPD with Dementia ([n (%)]	COPD without Dementia ([n (%)]	Unadjusted OR (95% CI)	Adjusted OR* (95% CI)	P value
41–64	15 (1.0)	1056 (0.5)	1.98 (1.18–3.30)	1.75 (1.04–2.92)	0.03
65–74	88 (1.5)	1915 (1.2)	1.25 (1.08–1.55)	1.23 (0.99–1.52)	0.07
≥75	478 (1.7)	2861 (1.7)	1.01 (0.92–1.11)	1.02 (0.92–1.12)	0.7

Note: *Adjusted for gender, modified Charlson comorbidity index, year, race and primary payer.

Abbreviaions: OR, odds ratio; CI, confidence interval.

Table 3 Proportional Hazard Ratios of Death Rates Stratified by Inpatient Length of Stay for Patients with and without Dementia

Inpatient length of stay	Unadjusted HR (95% CI)	COPD without Dementia ([n (%)]	P value
<5 days	1.79 (1.58–2.04)	1.23 (1.08–1.41)	0.002
5–100 days	1.09 (0.98–1.23)	0.88 (0.78–0.98)	0.03

Note: *Adjusted for age, gender, modified Charlson comorbidity index, year, race and primary payer.

Abbreviations: HR, hazard ratio; CI, confidence interval.

Table 4 Sub-Distribution Hazard Ratios of Inpatient Discharges for Patients with and without Dementia

Unadjusted SHR (95% CI)	Adjusted SHR* (95% CI)	P value
0.86 (0.85–0.87)	0.93 (0.92–0.94)	p<0.001

Note: *Adjusted for age, gender, modified Charlson comorbidity index, year, race and primary payer.

Abbreviations: SHR, sub-distribution hazard ratio; CI, confidence interval.