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      Economic Burden of COPD in the Presence of Comorbidities

      , MD, FCCP, , MPH, , PhD, MHA, , MS, , MS, , PhD, , PharmD

      Chest

      American College of Chest Physicians

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          Abstract

          BACKGROUND:

          The morbidity and mortality associated with COPD exacts a considerable economic burden. Comorbidities in COPD are associated with poor health outcomes and increased costs. Our objective was to assess the impact of comorbidities on COPD-associated costs in a large administrative claims dataset.

          METHODS:

          This was a retrospective observational study of data from the Truven Health MarketScan Commercial Claims and Encounters and the MarketScan Medicare Supplemental Databases from January 1, 2009, to September 30, 2012. Resource consumption was measured from the index date (date of first occurrence of non-rule-out COPD diagnosis) to 360 days after the index date. Resource use (all-cause and disease-specific [ie, COPD- or asthma-related] ED visits, hospitalizations, office visits, other outpatient visits, and total length of hospital stay) and health-care costs (all-cause and disease-specific costs for ED visits, hospitalizations, office visits, and other outpatient visits and medical, prescription, and total health-care costs) were assessed. Generalized linear models were used to evaluate the impact of comorbidities on total health-care costs, adjusting for age, sex, geographic location, baseline health-care use, employment status, and index COPD medication.

          RESULTS:

          Among 183,681 patients with COPD, the most common comorbidities were cardiovascular disease (34.8%), diabetes (22.8%), asthma (14.7%), and anemia (14.2%). Most patients (52.8%) had one or two comorbidities of interest. The average all-cause total health-care costs from the index date to 360 days after the index date were highest for patients with chronic kidney disease ($41,288) and anemia ($38,870). The impact on total health-care costs was greatest for anemia ($10,762 more, on average, than a patient with COPD without anemia).

          CONCLUSIONS:

          Our analysis demonstrated that high resource use and costs were associated with COPD and multiple comorbidities.

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          Most cited references 15

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          Prevalence and outcomes of diabetes, hypertension and cardiovascular disease in COPD.

          Chronic obstructive pulmonary disease (COPD) is associated with important chronic comorbid diseases, including cardiovascular disease, diabetes and hypertension. The present study analysed data from 20,296 subjects aged > or =45 yrs at baseline in the Atherosclerosis Risk in Communities Study (ARIC) and the Cardiovascular Health Study (CHS). The sample was stratified based on baseline lung function data, according to modified Global Initiative for Obstructive Lung Disease (GOLD) criteria. Comorbid disease at baseline and death and hospitalisations over a 5-yr follow-up were then searched for. Lung function impairment was found to be associated with more comorbid disease. In logistic regression models adjusting for age, sex, race, smoking, body mass index and education, subjects with GOLD stage 3 or 4 COPD had a higher prevalence of diabetes (odds ratio (OR) 1.5, 95% confidence interval (CI) 1.1-1.9), hypertension (OR 1.6, 95% CI 1.3-1.9) and cardiovascular disease (OR 2.4, 95% CI 1.9-3.0). Comorbid disease was associated with a higher risk of hospitalisation and mortality that was worse in people with impaired lung function. Lung function impairment is associated with a higher risk of comorbid disease, which contributes to a higher risk of adverse outcomes of mortality and hospitalisations.
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            Chronic obstructive pulmonary disease as a risk factor for cardiovascular morbidity and mortality.

            Chronic obstructive pulmonary disease and other disorders, associated with reduced lung function, are strong risk factors for cardiovascular events, independent of smoking. Overall, when the lowest quintile of lung function, as measured by FEV1 is compared with the highest quintile, the risk of cardiovascular mortality increases by approximately 75% in both men and women. Having symptoms of chronic bronchitis alone increases the risk of coronary deaths by 50%. Reduced ratio of FEV1 to FVC by itself is a modest independent risk factor for coronary events, increasing the risk by 30%. However, if patients have ventricular arrhythmias, the risk of coronary events is increased twofold, suggesting that the cardiotoxic effects of obstructive airways disease are amplified in those who have underlying cardiac rhythm disturbances. In general, for every 10% decrease in FEV1, all-cause mortality increases by 14%, cardiovascular mortality increases by 28%, and nonfatal coronary event increases by almost 20%. These data indicate that chronic obstructive pulmonary disease is a powerful, independent risk factor for cardiovascular morbidity and mortality.
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              Deaths: preliminary data for 2011.

              This report presents preliminary U.S. data on deaths, death rates, life expectancy, leading causes of death, and infant mortality for 2011 by selected characteristics such as age, sex, race, and Hispanic origin. Data in this report are based on death records comprising more than 98 percent of the demographic and medical files for all deaths in the United States in 2011. The records are weighted to independent control counts for 2011. Comparisons are made with 2010 final data. The age-adjusted death rate decreased from 747.0 deaths per 100,000 population in 2010 to 740.6 deaths per 100,000 population in 2011. From 2010 to 2011, age-adjusted death rates decreased significantly for 5 of the 15 leading causes of death: Diseases of heart, Malignant neoplasms, Cerebrovascular diseases, Alzheimer's disease, and Nephritis, nephrotic syndrome and nephrosis. The age-adjusted death rate increased for six leading causes of death: Chronic lower respiratory diseases, Diabetes mellitus, Influenza and pneumonia, Chronic liver disease and cirrhosis, Parkinson's disease, and Pneumonitis due to solids and liquids. Life expectancy remained the same in 2011 as it had been in 2010 at 78.7 years.
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                Author and article information

                Journal
                Chest
                Chest
                chest
                Chest
                Chest
                American College of Chest Physicians
                0012-3692
                1931-3543
                July 2015
                12 February 2015
                12 February 2015
                : 148
                : 1
                : 138-150
                Affiliations
                From the University of Kentucky College of Public Health (Dr Mannino), Lexington, KY; Novartis Pharmaceuticals Corporation (Ms Higuchi and Drs Yu, Tian, and Suh), East Hanover, NJ; KMK Consulting Inc (Ms Zhou), Florham Park, NJ; and Beijing Foreign Enterprises Human Resources Services Co, Ltd (Ms Li), Beijing, China.
                Author notes
                CORRESPONDENCE TO: David M. Mannino, MD, FCCP, Department of Preventive Medicine and Environmental Health, University of Kentucky College of Public Health, 111 Washington Ave, Ste 220, Lexington, KY 40536; e-mail: dmannino@ 123456uky.edu
                Article
                chest.14-2434
                10.1378/chest.14-2434
                4493870
                25675282
                © 2015 AMERICAN COLLEGE OF CHEST PHYSICIANS

                This is an open access article distributed under the terms of the Creative Commons Attribution-Noncommercial License ( http://creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted use, distribution, and reproduction to noncommercial entities, provided the original work is properly cited. Information for reuse by commercial entities is available online.

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                Categories
                Original Research
                COPD

                Respiratory medicine

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