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. 2020 Feb 19:15:389-395.
doi: 10.2147/COPD.S234363. eCollection 2020.

Using the BODE Index and Comorbidities to Predict Health Utilization Resources in Chronic Obstructive Pulmonary Disease

Chin-Ling Li  1   2 , Mei-Hsin Lin  1 , Pei-Shiuan Chen  1 , Yuh-Chyn Tsai  1   2 , Lien-Shi Shen  1   2 , Ho-Chang Kuo  1   3   4 , Shih-Feng Liu  1   4   5
Affiliations

Using the BODE Index and Comorbidities to Predict Health Utilization Resources in Chronic Obstructive Pulmonary Disease

Chin-Ling Li et al. Int J Chron Obstruct Pulmon Dis. .

Abstract

Background and objective: Chronic Obstructive Pulmonary Disease (COPD) is a common chronic respiratory disease that in the long term may develop into respiratory failure or even cause death and may coexist with other diseases. Over time, it may incur huge medical expenses, resulting in a heavy socio-economy burden. The BODE (Body mass index, airflow Obstruction, Dyspnea, and Exercise capacity) index is a predictor of the number and severity of acute exacerbations of COPD. This study focused on the correlation between the BODE index, comorbidity, and healthcare resource utilization in COPD.

Patients and methods: This is a retrospective study of clinical outcomes of COPD patients with complete BODE index data in our hospital from January 2015 to December 2016. Based on the patients' medical records in our hospital's electronic database from January 1, 2015 to August 31, 2017, we analyzed the correlation between BODE index, Charlson comorbidity index (CCI), and medical resources.

Results: Of the 396 patients with COPD who met the inclusion criteria, 382 (96.5%) were male, with an average age of 71.3 ± 8.4 years. Healthcare resource utilization was positively correlated with the BODE index during the 32 months of retrospective clinical outcomes. The study found a significant association between the BODE index and the CCI of COPD patients (p < 0.001). In-hospitalization expenses were positively correlated with CCI (p < 0.001). Under the same CCI, the higher the quartile, the higher the hospitalization expenses. BODE quartiles were positively correlated with number of hospitalizations (p < 0.001), hospitalization days (p < 0.001), hospitalization expenses (p = 0.005), and total medical expenses (p = 0.024).

Conclusion: This study demonstrates the value of examining the BODE index and comorbidities that can predict healthcare resource utilization in COPD.

Keywords: 6 min walk test; BODE index; Charlson comorbidity index; chronic obstructive pulmonary disease; medical burden.

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Conflict of interest statement

The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Flow chart of participant selection in this study.
Figure 2
Figure 2
Line of positive correlation between BODE quartiles and Charlson comorbidity index (p < 0.001). Notes: Post hoc comparison with Scheffé’s method for significant difference between BODE quartile 1 and quartile 4 (p = 0.024).
Figure 3
Figure 3
Hospitalization expenses by BODE quartiles for the high CCI and low CCI groups. Patients with high CCI level had higher hospitalization expenses than those with low CCI level after adjusting for BODE quartiles (p < 0.001).
Figure 4
Figure 4
Non-linear trend of number of outpatient visits by BODE quartiles (p = 0.462).
Figure 5
Figure 5
Linear trend of number of hospitalizations by BODE quartile (p < 0.001). Notes: The relation among BODE quartiles by number of hospitalizations after post hoc comparison with Scheffé’s method is BODE quartile 1 = quartile 2 < quartile 3 < quartile 4.
Figure 6
Figure 6
Linear trend of length of hospital stay by BODE quartile (p < 0.001). Notes: The relation among BODE quartiles for length of hospital stay after post hoc comparison with Scheffeé’s method is BODE quartile 1 = quartile 2 < quartile 3 < quartile 4.
Figure 7
Figure 7
Non-linear trend of outpatient expenses by BODE quartile (p = 0.532).
Figure 8
Figure 8
Relation between BODE quartiles and hospitalization. Overall p-value is marginally significant (p = 0.047) after multiple comparisons.
Figure 9
Figure 9
This shows linear trend among BODE quartiles with total medical expenses (p = 0.024).
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