The COPD-induced hospitalization burden from first admission to death.

BACKGROUND

Hospitalization periods at the exacerbation stage of COPD place a major burden on the health services and entail substantial costs. Little is known, however, about the corresponding burden on hospitals as the disease advances. We therefore set out to determine from hospital discharge and cause of death registers the overall burden on hospital resources occasioned by a COPD patient on a relative time scale from first admission to death, differentiated by age group, prognosis and sex.

METHODS

Data on all subsequent hospital treatment periods after the first for patients with COPD who were over 44 years of age on admission were gathered from the Finnish National Research and Development Centre for Welfare and Health for the period 1991-2001. The actual material for this study consisted of the data on those patients who were alive after the first treatment period but had died by 2001. These were divided into three survival groups.

RESULTS

The 8325 patients in this material had a total of 35,814 hospitalization periods in 1991-2001, of which men accounted for 73.6%. A total of 1895 of the patients (22.8%) had died within a year, 4257 (51.1%) within 1-5 years and 2173 (26.1%) after more than 5 years. Of those dying within a year, 20.9% had been in hospital care, while of those who lived on for over a year, 4.5% were in hospital when two-thirds of their remaining lifetime was still ahead of them and 7.3% when one-tenth of that time was still ahead.

CONCLUSIONS

Almost one-fourth of the COPD patients had died within a year of first hospital admission for the disease. This group with a poor prognosis made abundant use of hospital services. The burden imposed on such services by severe COPD patients is U-shaped, with hospital use increasing towards the end of their lives.