Population-Based Burden of COPD-Related Visits in the ED: Return ED Visits, Hospital Admissions, and Comorbidity Risks

doi:10.1378/chest.12-1899

Chest

Volume 144, Issue 3, September 2013, Pages 784-793

https://doi.org/10.1378/chest.12-1899 Get rights and content

Background

Little is known about the population-based burden of ED care for COPD.

Methods

We analyzed statewide ED surveillance system data to quantify the frequency of COPD-related ED visits, hospital admissions, and comorbidities.

Results

In 2008 to 2009 in North Carolina, 97,511 COPD-related ED visits were made by adults ≥ 45 years of age, at an annual rate of 13.8 ED visits/1,000 person-years. Among patients with COPD (n = 33,799), 7% and 28% had a COPD-related return ED visit within a 30- and 365-day period of their index visit, respectively. Compared with patients on private insurance, Medicare, Medicaid, and noninsured patients were more likely to have a COPD-related return visit within 30 and 365 days and have three or more COPD-related visits within 365 days. There were no differences in return visits by sex. Fifty-one percent of patients with COPD were admitted to the hospital from the index ED visit. Subsequent hospital admission risk in the cohort increased with age, peaking at 65 to 69 years (risk ratio [RR], 1.41; 95% CI, 1.26-1.57); there was no difference by sex. Patients with congestive heart failure (RR, 1.29; 95% CI, 1.22-1.37), substance-related disorders (RR, 1.35; 95% CI, 1.13-1.60), or respiratory failure/supplemental oxygen (RR, 1.25; 95% CI, 1.19-1.31) were more likely to have a subsequent hospital admission compared with patients without these comorbidities.

Conclusions

The population-based burden of COPD-related care in the ED is significant. Further research is needed to understand variations in COPD-related ED visits and hospital admissions.

Section snippets

Data Sources

Statewide ED visit data from January 1, 2008, through December 31, 2009, were obtained from the North Carolina Public Health Data Group and the North Carolina Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT) surveillance system. Through legislative mandate, all North Carolina acute care, hospital-affiliated civilian EDs that are open 24/7 in North Carolina are required to provide data on all ED visits to the NC DETECT surveillance system at least daily. Hospitals perform

Demographic Characteristics of COPD-Related ED Visits

In North Carolina in 2008 to 2009, 97,511 COPD-related ED visits were made by adults aged ≥ 45 years. The incidence rate was 13.78 ED visits/1,000 person-years (Table 1). The highest numbers of visits were found in the 65 to 69 years (14,001 or 14.4%) and 60 to 64 years (13,413 or 13.8%) age groups. Incidence rates were highest among the older age groups 75 to 79, 80 to 84, and 85 to 89 years. Women made more visits than men. Both the number of visits and incidence rates were higher among

Discussion

Little population-based research has been conducted to estimate the burden of COPD-related ED visits. NC DETECT, a surveillance system that captures 99.5% of ED visits in North Carolina, provided an excellent opportunity to characterize COPD-related ED visits among a large population. We found that the COPD-related ED visit rate of 13.8 per 1,000 person-years among adults 45 years and older for 2008 to 2009 was higher than a national average of 8.72 per 1,000 person-years for 1992 to 2000 for

Acknowledgments

Author contributions: Dr Yeatts takes responsibility for the integrity of the data and the accuracy of the data analysis.

Dr Yeatts: contributed to the study supervision, study concept and design, analysis and interpretation of the data, and statistical analysis; drafted the manuscript; and contributed critical revisions of the manuscript for important intellectual content.

Mr Lippmann: contributed to the concept and design, analysis and interpretation of the data, statistical analysis, and

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Funding/Support: The statistical analysis for this research was partially supported by a University of North Carolina, Gillings School of Global Public Health Gillings Innovation Grant. Drs Lich and Weinberger's time was partially supported by the National Center for Research Resources [Award KL2RR025746 to Dr Lich], a VA Senior Research Career Scientist Award from the Health Services Research and Development Service [RCS 91-408] (Dr Weinberger). North Carolina Disease Event Tracking and Epidemiologic Collection Tool data were provided by the North Carolina Public Health Data Group.

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Chest

Original ResearchCOPDPopulation-Based Burden of COPD-Related Visits in the ED: Return ED Visits, Hospital Admissions, and Comorbidity Risks

Background

Methods

Results

Conclusions

Section snippets

Data Sources

Demographic Characteristics of COPD-Related ED Visits

Discussion

Acknowledgments

Lancet

Respir Med

Chest

Am J Med

Ann Epidemiol

Chest

Chest

Chronic obstructive pulmonary disease surveillance—United States, 1971-2000

MMWR Surveill Summ

Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD Executive Summary

Am J Respir Crit Care Med

Chronic obstructive pulmonary disease with lung cancer and/or cardiovascular disease

Proc Am Thorac Soc

Public health strategic framework for COPD prevention. Centers for Disease Control website

Carolina Center for Health Informatics, Department of Emergency Medicine, University of North Carolina at Chapel Hill; 2011. NC Disease Event Tracking and Epidemiologic Collection Tool website

North Carolina State Demographics Branch of the Office of State Budget and Management

Morbidity and mortality 2012 chartbook on cardivascular, blood, and lung diseases

Original Research
COPD
Population-Based Burden of COPD-Related Visits in the ED: Return ED Visits, Hospital Admissions, and Comorbidity Risks