Agencia de Qualitat i Avaluació Sanitaria de Catalunya (AQuAS), Spain.
Hospital Clinic, Univ. Barcelona, Spain; Master Plan for Respiratory Diseases (PDMAR), Departament de Salut, Govern de la Generalitat de Catalunya, Spain; REDISSEC, Health Services Research on Chronic Patients Network, Instituto de Salud Carlos III, Spain.
Respir Med. 2018 Dec;145:219-225. doi: 10.1016/j.rmed.2018.01.008. Epub 2018 Jan 16.
Patients with Chronic Obstructive Pulmonary Disease (COPD) may suffer episodes of exacerbation (ECOPD) that require hospitalization and worsen their health status, and prognosis. We hypothesized that a detailed interrogation of health-care "big data" databases can provide valuable information to better understand the risk factors and outcomes of these episodes.
We interrogated four databases of the Catalan health-care system (>8,000,000 registries) to identify patients hospitalized because of ECOPD for the first time (index event) between 2010 and 2012. Analysis was carried forward since the index event until the end of 2014 or the death of the patient. The two years that preceded the index event were also investigated.
We identified 17,555 patients, (≥50 years of age) hospitalized because of ECOPD (ICD9 v.9 codes at discharge) for the first time between 2010 and 2012. In this population we observed that: (1) 23% of patients die within a year after being discharged from their first ECOPD hospitalization; (2) in the remaining patients, all-cause mortality was related to the number of re-hospitalizations, particularly with early (<30 days) readmissions; (3) despite this being a 'respiratory' cohort, prescription and dispensation of drugs for cardiovascular diseases was higher than for obstructive airway diseases; and, finally, (4) lower winter ambient temperatures are associated with hospital admissions for ECOPD particularly in early re-admitters.
Overall these results indicate under appreciation of the burden of COPD in patients hospitalized for the first time because ECOPD.
慢性阻塞性肺疾病（COPD）患者可能会经历加重期（ECOPD），需要住院治疗，从而导致健康状况和预后恶化。我们假设对医疗保健“大数据”数据库进行详细调查可以提供有价值的信息，以更好地了解这些发作的危险因素和结果。
我们调查了加泰罗尼亚医疗保健系统的四个数据库（>800 万份记录），以确定 2010 年至 2012 年间因首次 ECOPD 住院的患者（索引事件）。分析从索引事件开始一直进行到 2014 年底或患者死亡。还调查了索引事件发生前的两年。
我们确定了 17555 名患者（年龄≥50 岁），他们在 2010 年至 2012 年间因首次 ECOPD（出院时的 ICD9 v.9 代码）住院。在该人群中，我们观察到：（1）23%的患者在首次 ECOPD 住院后一年内死亡；（2）在其余患者中，全因死亡率与再住院次数有关，尤其是早期（<30 天）再次入院；（3）尽管这是一个“呼吸系统”队列，但心血管疾病药物的处方和配药量高于阻塞性气道疾病；最后，（4）冬季环境温度较低与 ECOPD 的住院治疗有关，尤其是在早期再入院者中。
总体而言，这些结果表明，首次因 ECOPD 住院的患者对 COPD 的负担认识不足。
