Chronic Obstructive Pulmonary Disease and Multimorbidity: Insights from a National Claims Administrative Database.

Abstract

Purpose: To estimate the prevalence of diagnosed chronic obstructive pulmonary disease (COPD) and characterize the frequency and distribution of multimorbidity among individuals with and without COPD in Colombia's contributory health system.

Patients and methods: We conducted a cross-sectional study using administrative healthcare data from the Capitation Unit Sufficiency Database (Unidad de Pago por Capitación, UPC) and the Unique Enrollees Database (Base de Datos Única de Afiliados, BDUA). An electronic algorithm was used to identify individuals with a COPD diagnosis and to estimate diagnosed COPD prevalence among all affiliates during 2018-2019. We also estimated the prevalence of selected health conditions among individuals with and without COPD. Differences between groups were assessed in two steps. First, standardized mean differences (SMDs) were calculated for prevalence estimates. Second, conditions with SMDs of approximately 0.1 or greater were further evaluated using prevalence ratios (PRs) adjusted for sex, region, age, insurer, and prior healthcare service utilization estimated with Poisson regression with robust variance and 95% confidence intervals.

Results: The study included 6,865,420 individuals. The nationwide prevalence of diagnosed COPD was 2.21% (95% CI, 2.20-2.22), with the highest prevalence observed in the Central region (2.77%; 95% CI, 2.74-2.79). In adjusted analyses, several conditions were more prevalent among individuals with COPD, including asthma (PR = 3.88; 95% CI, 2.88-5.23), sleep apnea (PR = 2.62; 95% CI, 2.05-3.35), heart failure (PR = 1.89; 95% CI, 1.29-2.78), ischemic heart disease (PR = 1.60; 95% CI, 1.26-2.03), hypertension (PR = 1.08; 95% CI, 1.02-1.15), and osteoporosis (PR = 2.34; 95% CI, 1.52-3.58), among others, were more prevalent among individuals with COPD. Lung cancer (PR = 6.41; 95% CI, 5.89-6.97) and breast cancer (PR = 1.17; 95% CI, 1.08-1.25) were also more prevalent in this population.

Conclusion: Individuals with diagnosed COPD in Colombia's contributory health system had a substantial burden of multimorbidity, particularly respiratory and cardiovascular conditions. These findings support interdisciplinary care models and locally tailored strategies to address regional differences in diagnosed COPD.