慢性阻塞性肺疾病患者出院后对冠状病毒 2019 住院的医疗利用。
Healthcare Utilization in Patients with Chronic Obstructive Pulmonary Disease Discharged from Coronavirus 2019 Hospitalization.
机构信息
Division of Pulmonary, Critical Care and Sleep Medicine, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA.
Division of Pulmonary Critical Care and Sleep Medicine, University of Texas Medical Branch, Galveston, TX, USA.
出版信息
Int J Chron Obstruct Pulmon Dis. 2023 Aug 22;18:1827-1835. doi: 10.2147/COPD.S415621. eCollection 2023.
RATIONALE
There is concern that patients with chronic obstructive pulmonary disease (COPD) are at greater risk of increased healthcare utilization (HCU) following Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-COV-2) infection.
OBJECTIVE
To assess whether COPD is an independent risk factor for increased post-discharge HCU.
METHODS
We conducted a retrospective cohort study of patients with COPD discharged home from a hospitalization due to Coronavirus Disease 2019 (COVID-19) between April 1, 2020, and March 31, 2021, using Optum's de-identified Clinformatics Data Mart Database (CDM). COVID-19 was identified by an International Classification of Diseases, tenth revision, clinical modification (ICD-10-CM) diagnosis code of U07.1. The primary outcome was HCU (ie, emergency department (ED) visits, readmissions, rehabilitation/skilled nursing facility (SNF) visits, outpatient office visits, and telemedicine visits) nine months post-discharge after COVID-19 hospitalization (from here on "post-discharge") in patients with COPD compared to HCU of patients without COPD. Poisson regression modeling was used to calculate relative risk (RR) and confidence interval (CI) for COPD, adjusted for the other covariates.
RESULTS
We identified a cohort of 160,913 patients hospitalized with COVID-19, with 57,756 discharged home and 14,622 (25.3%) diagnosed with COPD. Patients with COPD had a mean age of 75.48 years (±9.49); 55.5% were female and 70.9% were White. Patients with COPD had an increased risk of HCU in the nine months post-discharge after adjusting for the other covariates. Risk of ED visits, readmissions, length of stay during readmission, rehabilitation/SNF visits, outpatient office visits, and telemedicine visits were increased by 57% (RR 1.57; 95% CI 1.53-1.60), 50% (RR 1.50; 95% CI 1.46-1.54), 55% (RR 1.55; 95% CI 1.53-1.56), 18% (RR 1.18; 95% CI 1.14-1.22), 16% (RR 1.16; 95% CI 1.16-1.17), and 28% (RR 1.28; 95% CI 1.24-1.31), respectively. Younger patients (ages 18 to 65 years), women, and Hispanic patients with COPD showed an increased risk for post-discharge HCU.
CONCLUSION
Patients with COPD hospitalized with COVID-19 experienced increased HCU post-discharge compared to patients without COPD.
背景
人们担心患有慢性阻塞性肺疾病（COPD）的患者在感染严重急性呼吸综合征冠状病毒 2 型（SARS-CoV-2）后，其医疗保健利用（HCU）增加的风险更高。
目的
评估 COPD 是否是出院后 HCU 增加的独立危险因素。
方法
我们使用 Optum 的去识别 Clinformatics 数据集市数据库（CDM），对 2020 年 4 月 1 日至 2021 年 3 月 31 日期间因 2019 年冠状病毒病（COVID-19）出院回家的 COPD 患者进行了回顾性队列研究。COVID-19 通过国际疾病分类第十次修订临床修正（ICD-10-CM）的 U07.1 诊断代码识别。主要结局是与无 COPD 患者相比，COVID-19 住院后 9 个月（从这里称为“出院后”）出院的 COPD 患者的 HCU（即急诊就诊、再入院、康复/熟练护理设施（SNF）就诊、门诊就诊和远程医疗就诊）。使用泊松回归模型计算 COPD 的相对风险（RR）和置信区间（CI），并调整其他协变量。
结果
我们确定了一个因 COVID-19 住院的 160913 例患者队列，其中 57756 例出院回家，14622 例（25.3%）诊断为 COPD。患有 COPD 的患者平均年龄为 75.48 岁（±9.49）；55.5%为女性，70.9%为白人。在调整其他协变量后，患有 COPD 的患者在出院后 9 个月内 HCU 的风险增加。调整后，急诊就诊、再入院、再入院期间的住院时间、康复/SNF 就诊、门诊就诊和远程医疗就诊的风险分别增加了 57%（RR 1.57；95%CI 1.53-1.60）、50%（RR 1.50；95%CI 1.46-1.54）、55%（RR 1.55；95%CI 1.53-1.56）、18%（RR 1.18；95%CI 1.14-1.22）、16%（RR 1.16；95%CI 1.16-1.17）和 28%（RR 1.28；95%CI 1.24-1.31）。较年轻的患者（18 至 65 岁）、女性和患有 COPD 的西班牙裔患者出院后的 HCU 风险增加。
结论
与无 COPD 的患者相比，因 COVID-19 住院的 COPD 患者出院后 HCU 增加。
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