a Center for Outcomes Research , University of Illinois College of Medicine at Peoria , Peoria , IL , USA.
b Department of Internal Medicine , University of Illinois College of Medicine at Peoria , Peoria , IL , USA.
Curr Med Res Opin. 2019 Jul;35(7):1191-1196. doi: 10.1080/03007995.2019.1565531. Epub 2019 Jan 24.
Asthma/chronic obstructive pulmonary disease (COPD) overlap (ACO) is a recently described phenomenon defined as the coexistence of both asthma and COPD. Both asthma and COPD are known to result in increased emergency department (ED) visits and hospitalizations, but it is unclear how the ACO population utilizes these same healthcare resources. The objective of this study was to compare healthcare utilization in the ACO population versus the general population, the asthma population and the COPD population. We conducted a pooled cross-sectional statistical analysis using the 2012-2015 National Health Interview Survey (NHIS) data. We focused on adults 18 years of age and older and excluded pregnant women. We employed an adjusted logit regression model, where the primary outcomes were dichotomous indicators on healthcare utilizations including ED visits and hospital stays. A key covariate was a four-category variable: 1) no asthma or COPD; 2) asthma only; 3) COPD only; and 4) ACO. Other covariates included age, sex, race, education level, marital status, household income level, medical insurance status, smoking status, body mass index (BMI) category, region, year and comorbidities (cancer, diabetes, hypertension, coronary heart disease and ulcer). Adults with ACO were 134%, 53% and 21% more likely to have ED visits than the general population, asthma group and COPD group, respectively. For hospital stay, the ACO group was 120% and 86% more likely to be hospitalized than the general population and the asthma group respectively. In addition, adults with ACO were 61% and 130% more likely to have asthma exacerbations and asthma-related ED visits than the asthma group. ACO is a considerable risk factor for healthcare utilization versus the general population, the asthma population and the COPD population. Future focus should be placed on the ACO population to identify ways to reduce their healthcare utilization.
哮喘/慢性阻塞性肺疾病（COPD）重叠（ACO）是一种最近描述的现象，定义为同时存在哮喘和 COPD。哮喘和 COPD 均已知会导致急诊部（ED）就诊和住院次数增加，但尚不清楚 ACO 人群如何利用这些相同的医疗保健资源。本研究的目的是比较 ACO 人群与一般人群、哮喘人群和 COPD 人群的医疗保健利用情况。我们使用 2012-2015 年全国健康访谈调查（NHIS）数据进行了 pooled 横断面统计分析。我们关注 18 岁及以上的成年人，并排除了孕妇。我们采用了调整后的对数回归模型，主要结果是包括 ED 就诊和住院在内的医疗保健利用的二项指标。一个关键的协变量是一个四分类变量：1）无哮喘或 COPD；2）仅哮喘；3）仅 COPD；4）ACO。其他协变量包括年龄、性别、种族、教育水平、婚姻状况、家庭收入水平、医疗保险状况、吸烟状况、体重指数（BMI）类别、地区、年份和合并症（癌症、糖尿病、高血压、冠心病和溃疡）。与一般人群、哮喘组和 COPD 组相比，ACO 组成年人 ED 就诊的可能性分别高出 134%、53%和 21%。对于住院治疗，ACO 组比一般人群和哮喘组分别高出 120%和 86%的住院可能性。此外，与哮喘组相比，ACO 组成年人哮喘恶化和哮喘相关 ED 就诊的可能性分别高出 61%和 130%。与一般人群、哮喘人群和 COPD 人群相比，ACO 是医疗保健利用的一个重要危险因素。未来的重点应放在 ACO 人群上，以确定减少其医疗保健利用的方法。
