Merinopoulou Evie, Raluy-Callado Mireia, Ramagopalan Sreeram, MacLachlan Sharon, Khalid Javaria Mona
Real-World Evidence, Evidera, UK.
Takeda Development Centre Europe Ltd, London, UK.
Int J Chron Obstruct Pulmon Dis. 2016 Apr 1;11:697-709. doi: 10.2147/COPD.S100250. eCollection 2016.
Exacerbations of chronic obstructive pulmonary disease (COPD) are associated with accelerated disease progression and are important drivers of health care resource utilization. The study aimed to quantify the rates of COPD exacerbations in England and assess health care resource utilization by severity categories according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2013.
Data from the Clinical Practice Research Datalink linked to Hospital Episode Statistics were used to identify patients with a COPD diagnosis aged ≥40 years. Those with complete spirometric, modified Medical Research Council Dyspnea Scale information, and exacerbation history 12 months prior to January 1, 2011 (index date) were classified into GOLD severity groups. Study outcomes over follow-up (up to December 31, 2013) were exacerbation rates and resource utilization (general practitioner visits, hospital admissions).
From the 44,201 patients in the study cohort, 83.5% were classified into severity levels GOLD A: 33.8%, GOLD B: 21.0%, GOLD C: 18.1%, and GOLD D: 27.0%. Mean age at diagnosis was 66 years and 52.0% were male. Annual exacerbation rates per person-year increased with severity, from 0.83 (95% confidence interval [CI]: 0.81-0.85) for GOLD A to 2.51 (95% CI: 2.47-2.55) for GOLD D. General practitioner visit rates per person-year also increased with severity, from 4.82 (95% CI: 4.74-4.93) for GOLD A to 7.44 (95% CI: 7.31-7.61) for GOLD D. COPD-related hospitalization rates per person-year increased from less symptoms (GOLD A: 0.28, GOLD C: 0.39) to more symptoms (GOLD B: 0.52, GOLD D: 0.84).
Patients in the most severe category (GOLD D) experienced nearly three times the number of exacerbations and COPD-related hospitalizations as those in the least severe category (GOLD A), in addition to increased general practitioner visits. Better patient management to stabilize the disease progression could allow for an improvement in exacerbation frequency and a reduction in health care resource utilization.
慢性阻塞性肺疾病（COPD）急性加重与疾病进展加速相关，且是医疗资源利用的重要驱动因素。本研究旨在量化英格兰COPD急性加重的发生率，并根据慢性阻塞性肺疾病全球倡议组织（GOLD）2013版标准按严重程度类别评估医疗资源利用情况。
使用与医院事件统计数据相链接的临床实践研究数据链中的数据，识别年龄≥40岁的COPD诊断患者。将那些在2011年1月1日（索引日期）前12个月有完整肺功能测定、改良医学研究理事会呼吸困难量表信息及急性加重病史的患者分类到GOLD严重程度组。随访期间（至2013年12月31日）的研究结局为急性加重发生率和资源利用情况（全科医生就诊、住院）。
在研究队列的44,201名患者中，83.5%被分类到严重程度等级，GOLD A：33.8%，GOLD B：21.0%，GOLD C：18.1%，GOLD D：27.0%。诊断时的平均年龄为66岁，52.0%为男性。每人每年的急性加重发生率随严重程度增加，从GOLD A组的0.83（95%置信区间[CI]：0.81 - 0.85）增至GOLD D组的2.51（95% CI：2.47 - 2.55）。每人每年的全科医生就诊率也随严重程度增加，从GOLD A组的4.82（95% CI：4.74 - 4.93）增至GOLD D组的7.44（95% CI：7.31 - 7.61）。与COPD相关的每人每年住院率从症状较轻组（GOLD A：0.28，GOLD C：0.39）增至症状较重组（GOLD B：0.52，GOLD D：0.84）。
最严重类别（GOLD D）的患者经历的急性加重次数和与COPD相关的住院次数几乎是最不严重类别（GOLD A）患者的三倍，全科医生就诊次数也有所增加。更好地管理患者以稳定疾病进展可改善急性加重频率并减少医疗资源利用。
