The Permanente Medical Group, Kaiser Permanente Northern California, Oakland, CA, USA; Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA.
Spire Health, San Francisco, CA, USA.
Respir Med. 2023 Jan;206:107064. doi: 10.1016/j.rmed.2022.107064. Epub 2022 Nov 26.
Patients with chronic obstructive pulmonary disease (COPD) may have worse coronavirus disease-2019 (COVID-19)-related outcomes. We compared COVID-19 hospitalization risk in patients with and without COPD.
This retrospective cohort study included patients ≥40 years, SARS-CoV-2 positive, and with Kaiser Permanente Northern California membership ≥1 year before COVID-19 diagnosis (electronic health records and claims data). COVID-19-related hospitalization risk was assessed by sequentially adjusted logistic regression models and stratified by disease severity. Secondary outcome was death/hospice referral after COVID-19.
Of 19,558 COVID-19 patients, 697 (3.6%) had COPD. Compared with patients without COPD, COPD patients were older (median age: 69 vs 53 years); had higher Elixhauser Comorbidity Index (5 vs 0) and more median baseline outpatient (8 vs 4), emergency department (2 vs 1), and inpatient (2 vs 1) encounters. Unadjusted analyses showed increased odds of hospitalization with COPD (odds ratio [OR]: 3.93; 95% confidence interval [CI]: 3.40-4.60). After full risk adjustment, there were no differences in odds of hospitalization (OR: 1.14, 95% CI: 0.93-1.40) or death/hospice referral (OR: 0.96, 95% CI: 0.72-1.27) between patients with and without COPD. Primary/secondary outcomes did not differ by COPD severity, except for higher odds of hospitalization in COPD patients requiring supplemental oxygen versus those without COPD (OR: 1.84, 95% CI: 1.02-3.33).
Except for hospitalization among patients using supplemental oxygen, no differences in odds of hospitalization or death/hospice referral were observed in the COVID-19 patient sample depending on whether they had COPD.
患有慢性阻塞性肺疾病（COPD）的患者可能会有更差的 2019 年冠状病毒病（COVID-19）相关结局。我们比较了有和没有 COPD 的患者 COVID-19 住院的风险。
这项回顾性队列研究纳入了≥40 岁、SARS-CoV-2 阳性且在 COVID-19 诊断前至少有 1 年 Kaiser Permanente 北加州会员资格的患者（电子健康记录和索赔数据）。通过逐步调整的逻辑回归模型评估 COVID-19 相关住院风险，并按疾病严重程度分层。次要结局是 COVID-19 后死亡/临终关怀转诊。
在 19558 例 COVID-19 患者中，有 697 例（3.6%）患有 COPD。与没有 COPD 的患者相比，COPD 患者年龄更大（中位数年龄：69 岁 vs 53 岁）；Elixhauser 合并症指数更高（5 分 vs 0 分），基线门诊（8 次 vs 4 次）、急诊（2 次 vs 1 次）和住院（2 次 vs 1 次）就诊中位数更高。未调整的分析显示，COPD 患者住院的可能性增加（比值比[OR]：3.93；95%置信区间[CI]：3.40-4.60）。在充分调整风险后，COPD 患者与无 COPD 患者相比，住院（OR：1.14，95%CI：0.93-1.40）或死亡/临终关怀转诊（OR：0.96，95%CI：0.72-1.27）的可能性无差异。主要/次要结局不因 COPD 严重程度而不同，除了需要补充氧气的 COPD 患者住院的可能性高于无 COPD 患者（OR：1.84，95%CI：1.02-3.33）。
除了使用补充氧气的患者住院外，在 COVID-19 患者样本中，无论是否患有 COPD，住院或死亡/临终关怀转诊的可能性都没有差异。
