Blanchette Christopher M, Zacherle Emily, Noone Joshua M, Van Doren Bryce A, Roy Debosree, Howden Reuben
University of North Carolina, Charlotte NC, USA.
J Health Econ Outcomes Res. 2017 Jul 21;5(1):65-74. doi: 10.36469/9799. eCollection 2017.
Little is known about severe chronic obstructive pulmonary disease (COPD) exacerbations among patients with Alpha-1 Antitrypsin Deficiency (AATD). We assessed inpatients with AATD and COPD among a sample of COPD inpatients to ascertain demographic, clinical and economic differences in the course of disease and treatment. Using data from the 2009 Nationwide Inpatient Sample (NIS), we identified COPD (ICD-9-CM: 491.xx, 492.xx, or 496.xx) patients with AATD (273.4). We compared patient demographics and healthcare outcomes (eg, length of stay, inpatient death, type and number of procedures, and cost of care) between COPD patients with and without alpha-1 antitrypsin deficiency. Frequencies and percentages for patient demographics were compared using bivariate statistics (eg, chi-square test). Recognizing the non-parametric nature of length of stay and cost, we calculated median values and interquartile ranges for these variables for each group of patients. Finally, the risk of inpatient death was estimated using logistic regression. Of 840 242 patients with COPD (10.8% of the NIS sample population), 0.08% (684) had a primary or secondary diagnosis code for AATD. COPD+AATD were younger (56 vs 70, p<0.0001) and as a result, less likely to be covered by Medicare (44% vs 62%, p<0.0001). AATD patients were also more likely to have comorbid non-alcoholic liver disease (7% vs 2%, p<0.0001), depression (17% vs 13%, p=0.0328), and pulmonary circulation disorders (7% vs 4%, p=0.0299). Patients with AATD had a 14% longer length of stay (IRR = 1.14, 95% CI 1.07, 1.21) and a mean cost of $1487 (p=0.0251) more than COPD inpatients without AATD. AATD is associated with increased mean length of stay and cost, as well as higher frequency of comorbid non-alcoholic liver disease, depression, and pulmonary circulation disorders. Future research should assess other differences between AATD and the general COPD population such as natural history of disease, treatment responsiveness and disease progression.
关于α-1抗胰蛋白酶缺乏症（AATD）患者中的重度慢性阻塞性肺疾病（COPD）急性加重情况，人们了解甚少。我们在一组COPD住院患者样本中评估了患有AATD和COPD的住院患者，以确定疾病进程和治疗方面的人口统计学、临床及经济差异。利用2009年全国住院患者样本（NIS）的数据，我们识别出患有AATD（273.4）的COPD（国际疾病分类第九版临床修订本：491.xx、492.xx或496.xx）患者。我们比较了有和没有α-1抗胰蛋白酶缺乏症的COPD患者的人口统计学特征和医疗结局（如住院时间、住院死亡、手术类型和数量以及护理费用）。使用双变量统计（如卡方检验）比较患者人口统计学特征的频率和百分比。鉴于住院时间和费用的非参数性质，我们计算了每组患者这些变量的中位数和四分位数间距。最后，使用逻辑回归估计住院死亡风险。在840242例COPD患者（占NIS样本人群的10.8%）中，0.08%（684例）有AATD的原发性或继发性诊断编码。患有COPD+AATD的患者更年轻（56岁对70岁，p<0.0001），因此，被医疗保险覆盖的可能性更小（44%对62%，p<0.0001）。AATD患者也更有可能合并非酒精性肝病（7%对2%，p<0.0001）、抑郁症（17%对13%，p=0.0328）和肺循环障碍（7%对4%，p=0.0299）。与没有AATD的COPD住院患者相比，患有AATD的患者住院时间长14%（风险比=1.14，95%置信区间1.07，1.21），平均费用高出1487美元（p=0.0251）。AATD与平均住院时间延长、费用增加以及合并非酒精性肝病、抑郁症和肺循环障碍的频率较高有关。未来的研究应评估AATD与一般COPD人群之间的其他差异，如疾病自然史、治疗反应性和疾病进展。
