Geelhoed E A, Brameld K J, Holman C D J, Thompson P J
Asthma and Allergy Research Institute and The Centre for Asthma, Allergy and Respiratory Research, Perth, Western Australia, Australia.
Intern Med J. 2007 Feb;37(2):87-94. doi: 10.1111/j.1445-5994.2007.01240.x.
Exacerbations requiring hospital admission for chronic obstructive pulmonary disease (COPD) contribute to a decline in health status and are costly to the community. Long-term trends in admissions and associated outcomes are difficult to establish because of frequent readmissions, high case fatality and potential diagnostic transfer between COPD and asthma. The Western Australian Data Linkage System provides a unique opportunity to examine admissions for patients with COPD over the long term.
Nineteen years of hospital morbidity data, based on International Classification of Diseases-9 criteria were extracted from the Western Australian Data Linkage System (1980-1998) and merged with mortality records to examine trends in hospital admissions for COPD.
The rate of hospital admissions for COPD has declined overall and the rate of first presentation declined in men and remained constant in women. The risk of readmission increased throughout the period (P < 0.0001) and more than half of all admissions were followed by readmission within a year. Median survival following first admission was 6 years (men 5 years; women 8 years). Age, sex and International Classification of Diseases subcategory each showed an independent effect on the risk of mortality (P < 0.0001). The poorest survival was in patients subcategorized as emphysema. For patients with multiple admissions, the likelihood of cross-over between COPD and asthma was high and increased with the total number of admissions.
The rate of admission for COPD has declined in Western Australia; however, the resource burden will continue to increase because of the ageing population. This has policy implications for the development of acute care treatment programmes for COPD.
慢性阻塞性肺疾病（COPD）急性加重需要住院治疗，这会导致健康状况下降，且给社会带来高昂成本。由于频繁再入院、高病死率以及COPD与哮喘之间可能存在的诊断转换，难以确定入院情况及相关结局的长期趋势。西澳大利亚数据链接系统提供了一个独特的机会来长期研究COPD患者的入院情况。
根据国际疾病分类第9版标准，从西澳大利亚数据链接系统中提取了19年的医院发病率数据（1980 - 1998年），并与死亡记录合并，以研究COPD患者的入院趋势。
COPD的住院率总体呈下降趋势，男性首次入院率下降，女性保持稳定。在此期间，再入院风险持续增加（P < 0.0001），超过一半的入院患者在一年内再次入院。首次入院后的中位生存期为6年（男性5年；女性8年）。年龄、性别和国际疾病分类亚类对死亡风险均有独立影响（P < 0.0001）。归类为肺气肿的患者生存率最差。对于多次入院的患者，COPD与哮喘之间交叉的可能性很高，且随着入院总数的增加而增加。
西澳大利亚COPD的入院率有所下降；然而，由于人口老龄化，资源负担将继续增加。这对COPD急性护理治疗方案的制定具有政策意义。
