Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden.
Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden.
NPJ Prim Care Respir Med. 2018 Sep 10;28(1):33. doi: 10.1038/s41533-018-0101-y.
This study aimed to generate real-world evidence to assess the burden of comorbidities in COPD patients, to effectively manage these patients and optimize the associated healthcare resource allocation. ARCTIC is a large, real-world, retrospective cohort study conducted in Swedish COPD patients using electronic medical record data collected between 2000 and 2014. These patients were studied for prevalence of various comorbidities and for association of these comorbidities with exacerbations, mortality, and healthcare costs compared with an age-, sex-, and comorbidities-matched non-COPD reference population. A total of 17,479 patients with COPD were compared with 84,514 non-COPD reference population. A significantly higher prevalence of various comorbidities was observed in COPD patients 2 years post-diagnosis vs. reference population, with the highest percentage increase observed for cardiovascular diseases (81.8% vs. 30.7%). Among the selected comorbidities, lung cancer was relatively more prevalent in COPD patients vs. reference population (relative risk, RR = 5.97, p < 0.0001). Ischemic heart disease, hypertension, depression, anxiety, sleep disorders, osteoporosis, osteoarthritis, and asthma caused increased mortality rates in COPD patients. Comorbidities that were observed to be significantly associated with increased number of severe exacerbations in COPD patients included heart failure, ischemic heart disease, depression/anxiety, sleep disorders, osteoporosis, lung cancer, and stroke. The cumulative healthcare costs associated with comorbidities over 2 years after the index date were observed to be significantly higher in COPD patients (€27,692) vs. reference population (€5141) (p < 0.0001). The data support the need for patient-centered treatment strategies and targeted healthcare resource allocation to reduce the humanistic and economic burden associated with COPD comorbidities.
这项研究旨在提供真实世界的证据，评估 COPD 患者合并症的负担，有效管理这些患者，并优化相关医疗资源的分配。ARCTIC 是一项在瑞典 COPD 患者中进行的大型真实世界回顾性队列研究，使用 2000 年至 2014 年期间收集的电子病历数据。研究了这些患者各种合并症的患病率，并比较了这些合并症与年龄、性别和合并症匹配的非 COPD 参考人群的急性加重、死亡率和医疗保健成本之间的关联。共比较了 17479 例 COPD 患者和 84514 例非 COPD 参考人群。与参考人群相比，COPD 患者在诊断后 2 年内观察到各种合并症的患病率显著升高，其中心血管疾病的百分比增加最高（81.8%比 30.7%）。在所选择的合并症中，肺癌在 COPD 患者中比在参考人群中更为常见（相对风险，RR=5.97，p<0.0001）。缺血性心脏病、高血压、抑郁、焦虑、睡眠障碍、骨质疏松症、骨关节炎和哮喘使 COPD 患者的死亡率增加。观察到与 COPD 患者严重急性加重次数增加显著相关的合并症包括心力衰竭、缺血性心脏病、抑郁/焦虑、睡眠障碍、骨质疏松症、肺癌和中风。与合并症相关的医疗保健总成本在指数日期后 2 年内观察到在 COPD 患者中明显更高（€27692）比参考人群（€5141）（p<0.0001）。数据支持需要以患者为中心的治疗策略和针对性的医疗资源分配，以减轻与 COPD 合并症相关的人文和经济负担。
