Integrative Toxicology, The National Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden.
Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden.
Int J Chron Obstruct Pulmon Dis. 2021 Mar 18;16:701-713. doi: 10.2147/COPD.S297943. eCollection 2021.
The aim of this study was to assess the association between exacerbation frequency and clinical and economic outcomes in patients with COPD.
Electronic medical record data linked to National Health Registries were collected from COPD patients at 52 Swedish primary care centers (2000-2014). The outcomes analyzed were exacerbation rate, mortality, COPD treatments, lung function and healthcare costs during the follow-up period. Based on the exacerbation rate two years before index date, the patients were initially classified into three groups, either 0, 1 or ≥2 exacerbations per year. After the index date, the classification into exacerbation groups was updated each year based on the exacerbation rate during the last year of follow-up. A sensitivity analysis was conducted excluding patients with asthma diagnosis from the analysis.
In total 18,586 COPD patients were analyzed. A majority of the patients (60-70%) who either have had no exacerbation or frequent exacerbations (≥2/year) during the pre-index period remained in their group (ie, with 0 or ≥2 annual exacerbations) during up to 11 years of follow-up. Compared with having no exacerbation, mortality was higher in patients having 1 (HR; 2.06 [1.93-2.20]) and ≥2 (4.58 [4.33-4.84]) exacerbations at any time during the follow-up. Lung function decline was more rapid in patients with frequent exacerbations and there was an almost linear relationship between exacerbations frequency and mortality. Total healthcare costs were higher in the frequent exacerbation group (≥2/year) than in patients with no or one exacerbation annually (p<0.0001 for both). The results did not differ from the main analysis after exclusion of patients with a concurrent asthma diagnosis.
In addition to faster lung function decline and increased mortality, frequent exacerbations in COPD patients imply a significant economic burden.
本研究旨在评估 COPD 患者的加重频率与临床和经济结局之间的关系。
从 52 家瑞典初级保健中心（2000-2014 年）的 COPD 患者的电子病历数据与国家健康登记处进行了关联。分析的结果包括加重率、死亡率、COPD 治疗、肺功能以及随访期间的医疗保健费用。根据指数日期前两年的加重率，患者最初分为三组，每年 0 次、1 次或≥2 次加重。在指数日期后，根据最后一年随访期间的加重率，每年更新加重组的分类。敏感性分析排除了分析中患有哮喘诊断的患者。
共分析了 18586 例 COPD 患者。大多数患者（60-70%）在预指数期内没有加重或频繁加重（≥2/年），在长达 11 年的随访期间仍留在他们的组（即每年 0 次或≥2 次加重）。与没有加重相比，在随访期间任何时候都有 1 次（HR；2.06 [1.93-2.20]）和≥2 次（4.58 [4.33-4.84]）加重的患者死亡率更高。频繁加重的患者肺功能下降更快，且加重频率与死亡率之间呈线性关系。在频繁加重组（≥2/年）中，总医疗保健费用高于每年有 1 次或无加重的患者（均<0.0001）。排除同时患有哮喘诊断的患者后，主要分析结果无差异。
除了更快的肺功能下降和更高的死亡率外，COPD 患者的频繁加重还意味着重大的经济负担。
