Center for Interstitial and Rare Lung Diseases, Pneumology and Respiratory Critical Care Medicine, Thoraxklinik, University of Heidelberg, Member of the German Center for Lung Research (DZL), Röntgenstr. 1, D-69126, Heidelberg, Germany.
Institute of Health Economics and Health Care Management, Helmholtz Zentrum München (GmbH) - German Research Center for Environmental Health, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Heidelberg, Germany.
Respir Res. 2020 Mar 26;21(1):73. doi: 10.1186/s12931-020-01335-x.
Interstitial lung disease (ILD) is a heterogeneous group of mainly chronic lung diseases differing in disease course and prognosis. For most subtypes, evidence on relevance and outcomes of hospitalisations is lacking.
Using German claims data we investigated number of hospitalisations (zero-inflated-negative-binomial models providing rate ratios (RR)) and time to first hospitalisation (Cox proportional-hazard models providing hazard ratios (RR)) for nine ILD-subtypes. Models were stratified by ILD-related and non-ILD-related hospitalisations. We adjusted for age, gender, ILD-subtype, ILD-relevant comorbidities and ILD-medication (immunosuppressive drugs, steroids, anti-fibrotic drugs).
Among 36,816 ILD-patients (mean age 64.7 years, 56.2% male, mean observation period 9.3 quarters), 71.2% had non-ILD-related and 56.6% ILD-related hospitalisations. We observed more and earlier non-ILD-related hospitalisations in ILD patients other than sarcoidosis. Medical ILD-treatment was associated with increased frequency and in case of late initiation, earlier (non-)ILD-related hospitalisations. Comorbidities were associated with generally increased hospitalisation frequency except for COPD (RR = 0.90) and PH (RR = 0.94) in non-ILD-related and for lung cancer in ILD-related hospitalisations (RR = 0.89). Coronary heart disease was linked with earlier (ILD-related: HR = 1.17, non-ILD-related HR = 1.19), but most other conditions with delayed hospitalisations.
Hospitalisations are frequent across all ILD-subtypes. The hospitalisation risk might be reduced independently of the subtype by improved management of comorbidities and improved pharmacological and non-pharmacological ILD therapy.
间质性肺疾病（ILD）是一组主要的慢性肺部疾病，其疾病过程和预后各不相同。对于大多数亚型，缺乏与住院相关的证据。
使用德国的索赔数据，我们研究了 9 种间质性肺病亚型的住院次数（零膨胀负二项模型提供比率比（RR））和首次住院时间（Cox 比例风险模型提供风险比（RR））。模型按间质性肺病相关和非间质性肺病相关住院进行分层。我们调整了年龄、性别、间质性肺病亚型、间质性肺病相关合并症和间质性肺病药物（免疫抑制剂、类固醇、抗纤维化药物）。
在 36816 名间质性肺病患者中（平均年龄 64.7 岁，56.2%为男性，平均观察期为 9.3 个季度），71.2%为非间质性肺病相关住院，56.6%为间质性肺病相关住院。我们观察到非结节病患者的非间质性肺病相关住院次数更多，且更早。医学间质性肺病治疗与增加的频率有关，并且在晚期开始时，与更早的（非）间质性肺病相关住院有关。除 COPD（RR=0.90）和 PH（RR=0.94）外，合并症与一般住院频率增加有关，而非间质性肺病相关的肺癌和间质性肺病相关的肺癌除外（RR=0.89）。冠心病与（间质性肺病相关：HR=1.17，非间质性肺病相关：HR=1.19）的住院时间更早，但大多数其他疾病的住院时间更晚。
所有间质性肺病亚型的住院频率都很高。通过改善合并症的管理和改善药理学和非药理学间质性肺病治疗，可能会降低住院风险，而与亚型无关。
