Trends in hospital admissions for chronic obstructive pulmonary disease over 16 years in Canada

Abstract

Background: Chronic obstructive pulmonary disease (COPD) is an ambulatory care-sensitive condition, and the rate of hospital admissions for COPD is an indicator of the quality of outpatient care. We sought to determine long-term trends in hospital admissions for COPD in Canada.

Methods: Using a comprehensive national database of hospital admissions in Canada, we identified those with a main discharge diagnosis of COPD for patients aged 40 years and older between 2002 and 2017. We calculated sex-specific, age-standardized trends in annual rates of hospital admissions for COPD separately for younger (40-64 yr) and older adults (≥ 65 yr). We used spline regression to examine changes in the admissions trends for each sex and age group.

Results: Over 16 years, 1 134 359 hospital admissions were for COPD. Between 2002 and 2017, the total number of admissions increased by 68.8%, from 52 937 to 89 384. The overall crude admission rate increased by 30.0%, from 368 to 479 per 100 000 population, and the sex-and age-standardized admission rate increased by 9.6%, from 437 to 479 per 100 000 population. Age-standardized rates increased by 12.2% among younger females, by 24.4% among younger males and by 29.8% among older females, but decreased by 9.0% among older males. Over the same period, the all-cause sex-and age-standardized admission rate declined by 23.0%.

Interpretation: Hospital admissions for COPD have increased since 2010, even after adjusting for population growth and aging, and despite declining rates of all-cause hospital admissions. The secular increase in COPD admissions indicates that the burden of COPD on Canadian health care systems is increasing.

Figure 1:

Annual number and crude and sex- and age-standardized rates per 100 000 population of hospital admissions for chronic obstructive pulmonary disease (COPD), by calendar year. Note: CI = confidence interval.

Figure 2:

Spline regressions for age-standardized rates per 100 000 population of hospital admissions for chronic obstructive pulmonary disease (COPD), by calendar year, among (A) younger adults aged 40–64 years and (B) older adults aged 65 years and older. Note that scales for the y-axis are different for each age group. Note: CI = confidence interval.

Figure 3:

Sex-and age-standardized rates of hospital admissions for chronic obstructive pulmonary disease (COPD) per 100 000 population and all-cause hospital admissions per 5000 population per fiscal year. Note: CI = confidence interval.

Figure 4:

In-hospital mortality per 100 hospital admissions for chronic obstructive pulmonary disease (COPD) by calendar year, among (A) younger adults aged 40–64 years and (B) older adults aged 65 years and older. Note that scales for the y-axis are different by age group. Solid lines indicate the curves fitted by spline regression, and points indicate the observed values. Note: CI = confidence interval.