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Health Indicator Report of COPD Hospitalizations and ED Visits

Chronic Obstructive Pulmonary Disease (COPD) is a large group of lung diseases characterized by airflow obstruction and is often associated with symptoms related to difficulty in breathing, but can be present without any symptoms. The most important and frequent conditions in COPD are chronic bronchitis and emphysema, but also includes other diagnoses. Chronic lower respiratory disease, primarily COPD, was the third leading cause of death in the United States in 2011 (1). COPD is the third leading cause of hospitalization in the United States with over 715,000 admissions in 2005 (2,3). Beginning in 2008, COPD surpassed stroke as the third leading cause of death in the U.S. (4,5). COPD accounts for 1.5 million emergency department (ED) visits annually, and the number of visits has been on the rise since the early 1990s (6). It has been shown that roughly two-thirds of patients in the emergency department with COPD symptoms are consequently admitted as inpatients (7). As of 2009, 11.8 million adults aged 18+ years in the United States reported having physician-diagnosed COPD, however it is commonly accepted that COPD is frequently underdiagnosed (8). There are also large racial, ethnic, socioeconomic, and gender biases in COPD prevalence. Since 1993, the rate of admission for COPD in women surpasses that of men. Between 1992 and 2006, the hospital discharge rate for COPD increased by 33.1% to 22.5 per 10,000 population (8). Further, hospitalization rates generally increase with age, and are highest in those 65 years of age and older. It is estimated that nearly 24% of all Americans 65 years and older have COPD (9).

COPD Hospitalizations: Number by Year, Utah, 2000-2012

Data Source

Utah Inpatient Hospital Discharge Data, Office of Health Care Statistics, Utah Department of Health

Data Interpretation Issues

A measure using all COPD hospitalizations will include some transfers between hospitals for the same person for the same event. Variations in the percentage of transfers or readmissions for the same event may vary by geographic area and could impact rates. Data on race and ethnicity are not routinely collected in all states. This data is not consistently recorded on medical records and when available is complicated further by non-standard definitions of race and ethnicity, the use of combined race/ethnicity, reporting of multiple race categories, and differences in self-report versus registrar reporting. Without reciprocal reporting agreements with abutting states, statewide measures and measures for geographic areas (e.g., counties) bordering other states may be underestimated because of health care utilization patterns. Each state must individually obtain permission to access and, in some states, provide payment to obtain the data. Veterans Affairs, Indian Health Services, and institutionalized (prison) populations are excluded. Practice patterns and payment mechanisms may affect diagnostic coding and decisions by health care providers to hospitalize patients. Sometimes the mailing address of a patient is listed as the residence address of the patient. Patients may be exposed to environmental triggers in multiple locations, but geographic information is limited to residence. Since the data capture hospital discharges (rather than admissions), patients admitted toward the end of the year and discharged the following year could be omitted from the admission year dataset. Data will need to be de-duplicated (i.e., remove duplicate records for the same event). There is usually a two-year lag period before data are available from the data owner.

Definition

__Hospitalizations__ [[br]] 1. Number of hospitalizations for COPD [[br]] 2. Crude rate of hospitalizations for COPD per 10,000 population [[br]] 3. Age-adjusted rate of hospitalization for COPD per 10,000 population aged 25 years or older __Emergency Department (ED) Visits__ [[br]] 4. Number of ED visits for COPD [[br]] 5. Crude rate of ED visits for COPD per 10,000 population [[br]] 6. Age-adjusted rate of ED visits for COPD per 10,000 population aged 25 years or older

Numerator

1. Hospitalizations during a calendar year with COPD (ICD-9-CM 490-492 or 496) as the primary diagnosis (all hospitalizations, including transfers) [[br]] 2. Hospitalizations during a calendar year with COPD (ICD-9-CM 490-492 or 496) as the primary diagnosis (all hospitalizations, including transfers) [[br]] 3. Hospitalizations during a calendar year with COPD (ICD-9-CM 490-492 or 496) as the primary diagnosis (all hospitalizations, including transfers) [[br]] 4. ED visits during a calendar year with COPD (ICD-9-CM 490-492 or 496) as the primary diagnosis (all ED visits, including transfers to other facilities) [[br]] 5. ED visits during a calendar year with COPD (ICD-9-CM 490-492 or 496) as the primary diagnosis (all ED visits, including transfers to other facilities) [[br]] 6. ED visits during a calendar year with COPD (ICD-9-CM 490-492 or 496) as the primary diagnosis (all ED visits, including transfers to other facilities)

Denominator

Midyear resident population estimates for the state from U.S. Census Bureau (for rate measures) Adjustment: Age-adjustment by the direct method to year 2000 U.S. standard population
Page Content Updated On 05/05/2015, Published on 07/23/2015
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Content updated: Tue, 20 Dec 2016 15:48:05 MST