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Population-based burden of COPD-related visits in the ED: return ED visits, hospital admissions, and comorbidity risks.

Yeatts KB, Lippmann SJ, Waller AE, Hassmiller Lich K, Travers D, Weinberger M, Donohue JF. Population-based burden of COPD-related visits in the ED: return ED visits, hospital admissions, and comorbidity risks. Chest. 2013 Sep 1; 144(3):784-93.

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BACKGROUND: Little is known about the population-based burden of ED care for COPD. METHODS: We analyzed statewide ED surveillance system data to quantify the frequency of COPD-related ED visits, hospital admissions, and comorbidities. RESULTS: In 2008 to 2009 in North Carolina, 97,511 COPD-related ED visits were made by adults 45 years of age, at an annual rate of 13.8 ED visits/1,000 person-years. Among patients with COPD (n = 33,799), 7% and 28% had a COPD-related return ED visit within a 30- and 365-day period of their index visit, respectively. Compared with patients on private insurance, Medicare, Medicaid, and noninsured patients were more likely to have a COPD-related return visit within 30 and 365 days and have three or more COPD-related visits within 365 days. There were no differences in return visits by sex. Fifty-one percent of patients with COPD were admitted to the hospital from the index ED visit. Subsequent hospital admission risk in the cohort increased with age, peaking at 65 to 69 years (risk ratio [RR], 1.41; 95% CI, 1.26-1.57); there was no difference by sex. Patients with congestive heart failure (RR, 1.29; 95% CI, 1.22-1.37), substance-related disorders (RR, 1.35; 95% CI, 1.13-1.60), or respiratory failure/supplemental oxygen (RR, 1.25; 95% CI, 1.19-1.31) were more likely to have a subsequent hospital admission compared with patients without these comorbidities. CONCLUSIONS: The population-based burden of COPD-related care in the ED is significant. Further research is needed to understand variations in COPD-related ED visits and hospital admissions.

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