COPD comorbidity profiles and two-year trajectory of acute and post-acute care utilization

Ernest Shen, Janet S Lee, Richard A Mularski, Phillip Crawford, Alan S Go, Sue H Sung, Grace H Tabada, Michael K Gould, Huong Q Nguyen
Chest 2021 January 19

BACKGROUND: Multiple morbidity is the norm in advanced COPD and contributes to high symptom burden and worse outcomes.

RESEARCH QUESTION: Can distinct comorbidity profiles be identified and validated in a community-based sample of patients with COPD from a large integrated health care system using a standard, commonly used diagnostic code-based comorbidity index and downstream 2-year health care utilization data?

STUDY DESIGN AND METHODS: In this retrospective cohort study, we used latent class analysis (LCA) to identify comorbidity profiles in a population-based sample of 91,453 patients with a COPD diagnosis between 2011 and 2015. We included specific comorbid conditions from the Charlson Comorbidity Index (CCI) and accounted for variation in underlying prevalence of different comorbidities across the three study sites. Socio-demographic, clinical and health care utilization data were obtained from electronic health records (EHR). Multivariable logistic regression was used to compare rates of acute and post-acute care utilization by class.

RESULTS: The mean age was 71±11 years, 55% were females, 23% were persons of color, and 80% were former or current smokers. LCA identified four distinct comorbidity profiles with progressively higher CCI scores: low morbidity (61%, 1.9 ± 1.4), metabolic-renal (21%, 4.7 ± 1.8), cardiovascular (12%, 4.6 ± 1.9), and multi-morbidity (7%, 7.5 ± 1.7). In multivariable models, during 2-years of follow up, there was a significant, non-overlapping increase in the odds of having any all-cause acute (hospitalizations, observation stays and emergency department visits) and post-acute care utilization across the comorbidity profiles.

INTERPRETATION: Distinct comorbidity profiles can be identified in patients with COPD using standard EHR- based diagnostic codes, and these profiles are associated with subsequent acute and post-acute care utilization. Population-based risk stratification schemes for end-to-end, comprehensive COPD management should consider integrating comorbidity profiles such as those found in this study.


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