Quantifying health services use for chronic obstructive pulmonary disease

Abstract

Rationale: Chronic obstructive pulmonary disease (COPD), a common manageable condition, is a leading cause of death. A better understanding of its impact on health-care systems would inform strategies to reduce its burden.

Objectives: To quantify health services use in a large, North American COPD population.

Methods: We conducted a cohort study using health administrative data from Ontario, a province with a population of 13 million and universal health-care insurance. All individuals with physician-diagnosed COPD in 2008 were identified and followed for 3 years. Proportions of all hospital visits, emergency department visits, ambulatory care visits, long-term care residence places, and homecare made or used by people with COPD were determined and rates of each compared between people with and without COPD.

Measurements and main results: A total of 853,438 individuals with COPD (11.8% of the population aged 35 yr and older) were responsible for 24% of hospitalizations, 24% of emergency department visits, and 21% of ambulatory care visits; filled 35% of long-term care places; and used 30% of homecare services. After adjusting for several factors, people with COPD had rates of hospital, emergency department, and ambulatory care visits that were, respectively, 63%, 85%, and 48% higher than the rest of the population. Their rates of long-term care and homecare use were 56 and 59% higher, respectively.

Conclusions: Individuals with COPD use large and disproportionate amounts of health services. Strategies that target this group are needed to improve their health and minimize their need for health services.