Authors: Gupta A, Lin C, Wang L, Yuce H, Aygenc G, Baser O

Objectives: Assess health care costs, 30-day readmission rates, and predictors of 30-day readmission among patients with chronic obstructive pulmonary disorder (COPD) in the US Veterans Health Administration (VHA) population (01OCT2011-30SEP2016).

Methods: Adult patients with ≥1 inpatient diagnosis for COPD (International Classification of Disease, 9th Revision, Clinical Modification codes 491, 492, 496) during the identification period (01OCT2012-30SEPT2015) were included from the VHA population. The initial diagnosis date was designated as the index date. Patients with the same age, sex, race, and index year as COPD patients, and without a COPD diagnosis, were identified as controls. The index date for the control group was randomly selected to minimize bias. Patients were required to have continuous medical and pharmacy benefits for ≥1 year pre- and post-index date. Health care costs and 30-day readmission rates during the 1-year follow-up period were compared among 1:1 matched patients with and without COPD. Predictors of 30-day readmission were examined using logistic regression.

Results: After matching, there were 30,412 patients in each group. The mean age was 72 years, and 73% of patients in each group were white. As compared to controls, cases had higher mean Charlson comorbidity index (CCI) scores (3.2 vs 1.2, p<0.0001); higher inpatient ($33,088 vs $1,120; p<0.0001), outpatient ($8,924 vs $2,520; p<0.0001), and total costs ($42,012 vs $3,640; p<0.0001); and higher 30-day readmission rates (17.4% vs 0.7%; p<0.0001). The multivariate analysis showed that the likelihood of 30-day readmission was significantly higher in those with higher CCI scores (odds ratio [OR]: 1.10; 95% confidence interval [CI]: 1.08-1.11) and COPD (OR: 25.19, 95% CI: 21.87-29.00). Age, sex, and race did not significantly affect 30-day readmissions.

Conclusions: Patients with COPD had significantly higher 30-day readmission rates and economic burden than those without COPD. A higher CCI score was considered a significant positive predictor of 30-day readmission.

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