疾病严重程度如何影响慢性阻塞性肺病患者的临床结果和经济负担——中国天津一项基于人群的回顾性队列研究

IF 3.1 3区 医学 Q2 RESPIRATORY SYSTEM
Lei Wang, Ke Huang, Xiaoning He, Jiahui Zhang, Ting Yang, Jing Wu
{"title":"疾病严重程度如何影响慢性阻塞性肺病患者的临床结果和经济负担——中国天津一项基于人群的回顾性队列研究","authors":"Lei Wang, Ke Huang, Xiaoning He, Jiahui Zhang, Ting Yang, Jing Wu","doi":"10.2147/COPD.S524647","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>Quantifying the disease burden across severity levels is essential for early intervention and effective management of chronic obstructive pulmonary disease (COPD). This study aimed to clarify the effect of severity on disease burden by comparing clinical and economic outcomes stratified by disease severity based on the Global Initiative for Chronic Obstructive Lung Disease (GOLD) in a Chinese setting.</p><p><strong>Methods: </strong>A retrospective population-based cohort study was conducted using electronic health records of 80 hospitals (2016-2019). Patients (≥40 years) diagnosed with COPD (ICD-10: J44) between 2017 and 2018 were identified and further classified into high (GOLD E) or low (GOLD A/B) exacerbation risk groups based on 12-months pre-index exacerbation history. GOLD groups A, B, and E were categorized based on exacerbation history and prior symptom burden. Clinical and economic outcomes were examined during 12-months follow-up, including incidence and time intervals between exacerbations, mortality, healthcare resource utilization, and direct medical costs.</p><p><strong>Results: </strong>Among 6759 COPD patients (mean age 68.36 ± 11.46 years, 62.4% male), patients in group E (N=2378) showed significantly worse outcomes than group A/B (N=4381): 57% higher exacerbations risk (90.5 vs 70.5%, adjusted hazard ratio [HR]=1.57; 95% CI: 1.48-1.67), 31% higher risk of all-cause mortality (11.6 vs 6.6%, HR=1.31; 95% CI: 1.10-1.57), and 1.7-fold higher COPD-related total costs (Chinese yuan [CNY] 21,156 vs 12,457, adjusted difference CNY 4238) during follow-up. Notably, the incidence rates of overall exacerbation, total costs increased progressively from group A to B to E in the year following the index date.</p><p><strong>Conclusion: </strong>Poor prognosis and high economic burden were observed among Chinese patients with COPD. Higher disease severity was associated with increased risk of exacerbation, all-cause mortality, and economic burden. These findings underscore the need for early intervention in patients with mild COPD to prevent disease progression, subsequent exacerbations, and rising economic impacts.</p>","PeriodicalId":48818,"journal":{"name":"International Journal of Chronic Obstructive Pulmonary Disease","volume":"20 ","pages":"2061-2072"},"PeriodicalIF":3.1000,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12206407/pdf/","citationCount":"0","resultStr":"{\"title\":\"How Does Disease Severity Affect Clinical Outcomes and Economic Burden of Patients with COPD -- A Retrospective Population-Based Cohort Study in Tianjin, China.\",\"authors\":\"Lei Wang, Ke Huang, Xiaoning He, Jiahui Zhang, Ting Yang, Jing Wu\",\"doi\":\"10.2147/COPD.S524647\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>Quantifying the disease burden across severity levels is essential for early intervention and effective management of chronic obstructive pulmonary disease (COPD). This study aimed to clarify the effect of severity on disease burden by comparing clinical and economic outcomes stratified by disease severity based on the Global Initiative for Chronic Obstructive Lung Disease (GOLD) in a Chinese setting.</p><p><strong>Methods: </strong>A retrospective population-based cohort study was conducted using electronic health records of 80 hospitals (2016-2019). Patients (≥40 years) diagnosed with COPD (ICD-10: J44) between 2017 and 2018 were identified and further classified into high (GOLD E) or low (GOLD A/B) exacerbation risk groups based on 12-months pre-index exacerbation history. GOLD groups A, B, and E were categorized based on exacerbation history and prior symptom burden. Clinical and economic outcomes were examined during 12-months follow-up, including incidence and time intervals between exacerbations, mortality, healthcare resource utilization, and direct medical costs.</p><p><strong>Results: </strong>Among 6759 COPD patients (mean age 68.36 ± 11.46 years, 62.4% male), patients in group E (N=2378) showed significantly worse outcomes than group A/B (N=4381): 57% higher exacerbations risk (90.5 vs 70.5%, adjusted hazard ratio [HR]=1.57; 95% CI: 1.48-1.67), 31% higher risk of all-cause mortality (11.6 vs 6.6%, HR=1.31; 95% CI: 1.10-1.57), and 1.7-fold higher COPD-related total costs (Chinese yuan [CNY] 21,156 vs 12,457, adjusted difference CNY 4238) during follow-up. Notably, the incidence rates of overall exacerbation, total costs increased progressively from group A to B to E in the year following the index date.</p><p><strong>Conclusion: </strong>Poor prognosis and high economic burden were observed among Chinese patients with COPD. Higher disease severity was associated with increased risk of exacerbation, all-cause mortality, and economic burden. These findings underscore the need for early intervention in patients with mild COPD to prevent disease progression, subsequent exacerbations, and rising economic impacts.</p>\",\"PeriodicalId\":48818,\"journal\":{\"name\":\"International Journal of Chronic Obstructive Pulmonary Disease\",\"volume\":\"20 \",\"pages\":\"2061-2072\"},\"PeriodicalIF\":3.1000,\"publicationDate\":\"2025-06-25\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12206407/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"International Journal of Chronic Obstructive Pulmonary Disease\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.2147/COPD.S524647\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q2\",\"JCRName\":\"RESPIRATORY SYSTEM\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"International Journal of Chronic Obstructive Pulmonary Disease","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.2147/COPD.S524647","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/1 0:00:00","PubModel":"eCollection","JCR":"Q2","JCRName":"RESPIRATORY SYSTEM","Score":null,"Total":0}
引用次数: 0

摘要

在严重程度上量化疾病负担对于慢性阻塞性肺疾病(COPD)的早期干预和有效管理至关重要。本研究旨在通过比较慢性阻塞性肺疾病全球倡议(GOLD)在中国背景下按疾病严重程度分层的临床和经济结果,阐明严重程度对疾病负担的影响。方法:采用80家医院(2016-2019年)的电子健康档案进行回顾性人群队列研究。2017年至2018年间诊断为COPD (ICD-10: J44)的患者(≥40岁)被确定,并根据12个月的指数前加重史进一步分为高(GOLD E)或低(GOLD A/B)加重风险组。GOLD组A、B和E根据加重史和既往症状负担进行分类。在12个月的随访期间检查了临床和经济结果,包括发病率和恶化之间的时间间隔、死亡率、医疗资源利用率和直接医疗费用。结果:6759例COPD患者(平均年龄68.36±11.46岁,男性占62.4%)中,E组(N=2378)患者的预后明显差于A/B组(N=4381):加重风险高57% (90.5 vs 70.5%,校正风险比[HR]=1.57;95% CI: 1.48-1.67),全因死亡风险增加31% (11.6 vs 6.6%, HR=1.31;95% CI: 1.10-1.57),随访期间copd相关总成本增加1.7倍(人民币[CNY] 21,156对12,457,调整后差异人民币4238)。值得注意的是,在指数日期后的一年中,从A组到B组到E组的总恶化发生率和总费用逐渐增加。结论:中国慢性阻塞性肺病患者预后差,经济负担高。较高的疾病严重程度与加重风险、全因死亡率和经济负担增加相关。这些发现强调了对轻度COPD患者进行早期干预的必要性,以防止疾病进展、随后的恶化和不断上升的经济影响。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

How Does Disease Severity Affect Clinical Outcomes and Economic Burden of Patients with COPD -- A Retrospective Population-Based Cohort Study in Tianjin, China.

How Does Disease Severity Affect Clinical Outcomes and Economic Burden of Patients with COPD -- A Retrospective Population-Based Cohort Study in Tianjin, China.

Introduction: Quantifying the disease burden across severity levels is essential for early intervention and effective management of chronic obstructive pulmonary disease (COPD). This study aimed to clarify the effect of severity on disease burden by comparing clinical and economic outcomes stratified by disease severity based on the Global Initiative for Chronic Obstructive Lung Disease (GOLD) in a Chinese setting.

Methods: A retrospective population-based cohort study was conducted using electronic health records of 80 hospitals (2016-2019). Patients (≥40 years) diagnosed with COPD (ICD-10: J44) between 2017 and 2018 were identified and further classified into high (GOLD E) or low (GOLD A/B) exacerbation risk groups based on 12-months pre-index exacerbation history. GOLD groups A, B, and E were categorized based on exacerbation history and prior symptom burden. Clinical and economic outcomes were examined during 12-months follow-up, including incidence and time intervals between exacerbations, mortality, healthcare resource utilization, and direct medical costs.

Results: Among 6759 COPD patients (mean age 68.36 ± 11.46 years, 62.4% male), patients in group E (N=2378) showed significantly worse outcomes than group A/B (N=4381): 57% higher exacerbations risk (90.5 vs 70.5%, adjusted hazard ratio [HR]=1.57; 95% CI: 1.48-1.67), 31% higher risk of all-cause mortality (11.6 vs 6.6%, HR=1.31; 95% CI: 1.10-1.57), and 1.7-fold higher COPD-related total costs (Chinese yuan [CNY] 21,156 vs 12,457, adjusted difference CNY 4238) during follow-up. Notably, the incidence rates of overall exacerbation, total costs increased progressively from group A to B to E in the year following the index date.

Conclusion: Poor prognosis and high economic burden were observed among Chinese patients with COPD. Higher disease severity was associated with increased risk of exacerbation, all-cause mortality, and economic burden. These findings underscore the need for early intervention in patients with mild COPD to prevent disease progression, subsequent exacerbations, and rising economic impacts.

求助全文
通过发布文献求助,成功后即可免费获取论文全文。 去求助
来源期刊
CiteScore
4.80
自引率
10.70%
发文量
372
审稿时长
16 weeks
期刊介绍: An international, peer-reviewed journal of therapeutics and pharmacology focusing on concise rapid reporting of clinical studies and reviews in COPD. Special focus will be given to the pathophysiological processes underlying the disease, intervention programs, patient focused education, and self management protocols. This journal is directed at specialists and healthcare professionals
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:604180095
Book学术官方微信