Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA.
Center for Health Research, Kaiser Permanente Northwest, Portland, OR.
Chest. 2021 Jun;159(6):2233-2243. doi: 10.1016/j.chest.2021.01.020. Epub 2021 Jan 19.
Multiple morbidity is the norm in advanced COPD and contributes to high symptom burden and worse outcomes.
Can distinct comorbidity profiles be identified and validated in a community-based sample of patients with COPD from a large integrated health care system using a standard, commonly used diagnostic code-based comorbidity index and downstream 2-year health care use data?
In this retrospective cohort study, we used latent class analysis (LCA) to identify comorbidity profiles in a population-based sample of 91,453 patients with a COPD diagnosis between 2011 and 2015. We included specific comorbid conditions from the Charlson Comorbidity Index (CCI) and accounted for variation in underlying prevalence of different comorbidities across the three study sites. Sociodemographic, clinical, and health-care use data were obtained from electronic health records (EHRs). Multivariate logistic regression analysis was used to compare rates of acute and postacute care use by class.
The mean age was 71 ± 11 years, 55% of patients were women, 23% of patients were people of color, and 80% of patients were former or current smokers. LCA identified four distinct comorbidity profiles with progressively higher CCI scores: low morbidity (61%; 1.9 ± 1.4), metabolic renal (21%; 4.7 ± 1.8), cardiovascular (12%; 4.6 ± 1.9), and multimorbidity (7%; 7.5 ± 1.7). In multivariate models, during 2 years of follow-up, a significant, nonoverlapping increase was found in the odds of having any all-cause acute (hospitalizations, observation stays, and ED visits) and postacute care use across the comorbidity profiles.
Distinct comorbidity profiles can be identified in patients with COPD using standard EHR-based diagnostic codes, and these profiles are associated with subsequent acute and postacute care use. Population-based risk stratification schemes for end-to-end, comprehensive COPD management should consider integrating comorbidity profiles such as those found in this study.
多种合并症是晚期 COPD 的常态，导致高症状负担和更差的结局。
能否使用标准的、常用的基于诊断代码的合并症指数和下游 2 年的医疗保健使用数据，在来自大型综合医疗保健系统的 COPD 患者的基于社区的样本中确定和验证不同的合并症特征？
在这项回顾性队列研究中，我们使用潜在类别分析（LCA）来识别 2011 年至 2015 年间患有 COPD 诊断的人群样本中的合并症特征。我们包括 Charlson 合并症指数（CCI）中的特定合并症，并考虑了三个研究地点之间不同合并症的基础患病率的变化。社会人口统计学、临床和医疗保健使用数据来自电子健康记录（EHR）。多变量逻辑回归分析用于按类别比较急性和亚急性护理的使用率。
平均年龄为 71 ± 11 岁，55%的患者为女性，23%的患者为有色人种，80%的患者为前吸烟者或现吸烟者。LCA 确定了四个不同的合并症特征，CCI 评分逐渐升高：低合并症（61%；1.9 ± 1.4）、代谢肾脏（21%；4.7 ± 1.8）、心血管（12%；4.6 ± 1.9）和多种合并症（7%；7.5 ± 1.7）。在多变量模型中，在 2 年的随访期间，在所有原因的急性（住院、观察停留和急诊就诊）和亚急性护理使用的几率方面，在合并症特征之间发现了显著的、不重叠的增加。
使用基于标准 EHR 的诊断代码可以在 COPD 患者中识别出不同的合并症特征，并且这些特征与随后的急性和亚急性护理使用相关。用于端到端、全面 COPD 管理的基于人群的风险分层方案应考虑整合本研究中发现的此类合并症特征。
