Yeatts leads study to analyze incidence and burden of COPD-related emergency department visits in NC
|May 08, 2013|
The U.S. Centers for Disease Control and Prevention reports that more than 15 million adults may be living with a lower respiratory ailment called chronic obstructive pulmonary disease (COPD) and that millions more may be unaware they have it.
Responding to the CDC’s call for increased analysis and dissemination of COPD-related public health data, researchers from The University of North Carolina at Chapel Hill examined records available through the North Carolina Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT) surveillance system to determine the population-based burden imposed on N.C. hospital systems by COPD-related emergency room visits.The results of their analysis were published online April 11 in CHEST, the official publication of the American College of Chest Physicians.
Led by Karin Yeatts, PhD, research assistant professor of epidemiology at Gillings School of Global Public Health, the study examined data on a cohort of 33,799 patients with a COPD diagnosis who received emergency department (ED) care between Jan. 1, 2008 and Dec. 31, 2009 in North Carolina.
Yeatts and colleagues focused upon the frequency of return visits to the ED within the following year, hospital admission(s) that followed ED care, and the potential risk of return visits for COPD patients with several comorbid conditions, including heart and respiratory disease.
COPD comprises a set of conditions, including emphysema and chronic bronchitis, which limit air flow and cause breathing difficulties. In the U.S., its main causes are tobacco use, air pollutants in home and work environments (e.g., secondhand smoke and fumes) and genetic factors.
Nationally, the more than 10 million adults with diagnosed COPD had an estimated 1.5 million ED visits and 726,000 hospitalizations in 2000.Yeatts and colleagues found that 97,511 COPD-related ED visits were made by adults 45 years of age and older during the two-year study period, with more visits made by women ages 60-69. The highest percentage of visits was among men 75 years of age and older.
Twenty-eight percent of the cohort had at least one return ED visit within 365 days, and 7 percent returned within 30 days. Medicare, Medicaid and non-insured patients were more likely to have a COPD-related return visit to the ED and to have more than three COPD-related ED visits within one year.
As a result of the first ED visit considered in the analysis (index), 51 percent of the COPD-related emergencies were admitted to the hospital, an admission rate twice as high as the overall hospitalization rate for all ED visits made by patients 45 years of age and older. Patients with congestive heart failure, substance-related disorders or respiratory failure were more likely to have subsequent hospital admission(s) compared to patients without those comorbidities.
Patients enrolled in Medicare and Medicaid were 29 percent and 35 percent more likely, respectively, to have one or more hospital admissions compared to those with private insurance. Patients with no insurance were 28 percent less likely than the privately insured to have a subsequent hospital admission.Comorbidities of respiratory failure and congestive heart failure had the highest association for increased hospital admissions. Though “substance-related disorders” was comorbid only in a small percentage of the cohort (1.5 percent), that condition, particularly cocaine use, had the most significant association with subsequent hospital admission.
“We found a high burden of care both for repeat visits and hospital admissions for COPD-related illness in this North Carolina population,” Yeatts said. “Our analysis suggests that the smoking rate in N.C. may have impact, the uninsured do not get all the care they need, and older women are at equal risk compared with men.”
Other study co-authors from the Gillings School of Global Public Health are epidemiology doctoral student Steven J. Lippmann, MSPH; and Kristen Hassmiller Lich, PhD, research assistant professor, and Morris Weinberger, PhD, Vergil N. Slee Distinguished Professor of Healthcare Quality Management, both in the Department of Health Policy and Management.
Co-authors from the UNC School of Medicine are Anna E. Waller, ScD, research associate professor at the Carolina Center for Health Informatics and Department of Emergency Medicine, and James F. Donohue, MD, professor of medicine in the Department of Pulmonary Diseases and Critical Care Medicine.
Debbie Travers, PhD, RN, is an assistant professor in the School of Nursing the Department of Emergency Medicine and the Carolina Center for Health Informatics.
Weinberger also is in the Center for Health Services Research in Primary Care at the Durham (N.C.) VA Medical Center.The authors wish to note the collaborative and interdisciplinary nature of this effort, which was conducted by researchers in epidemiology, emergency medicine, health policy and management, nursing, and pulmonary diseases and critical care medicine. Their collaboration began through a 2008 Gillings Innovation Laboratory (GIL) grant awarded to David Richardson, PhD, associate professor of epidemiology.