Standard diagnostic codes and data obtained from electronic health records (EHR) may identify distinct comorbidity profiles and predict subsequent acute and post-acute healthcare utilization in patients with chronic obstructive pulmonary disease (COPD), according to a study in CHEST.
Researchers from the Kaiser Permanente healthcare system retrospectively reviewed comorbidity profiles in EHRs of 91,453 patients who received a COPD diagnosis between 2011 and 2015. The investigators identified specific comorbid conditions using indicators from the Charlson Comorbidity Index (CCI). Other data collected from the patient records included sociodemographic, clinical, and healthcare utilization data. The researchers compared rates of acute and post-acute care utilization by class using multivariable logistic regression.
Overall, the mean age of the patients was 71±11 years, and roughly half (55%) of patients were women. Approximately 23% of patients were people of color, and nearly 80% of patients were either former or current smokers.
The latent class analysis identified 4 distinct comorbidity profiles with progressively higher scores on the CCI. These included low morbidity (61%; 1.9±1.4), metabolic-renal (21%; 4.7±1.8), cardiovascular (12%; 4.6±1.9), and multimorbidity (7%; 7.5±1.7). Compared with patients in the higher comorbidity profiles, patients in the low morbidity profile were younger (mean age, 68 vs 74 years; P <.001), current smokers (13% vs 20%; P <.001), and more physically active (51% engaged in at least some moderate activity in a week vs 40%; P <.001).
During a 2-year follow-up period, the researchers found significant increases in the odds of any all-cause acute and post-acute healthcare utilization across the comorbidity profiles. All-cause acute utilization included hospitalizations, observation stays, and emergency department visits.
A limitation of this study included the lack of spirometry data for approximately half of the cohort, which could have resulted in COPD misclassification.
The investigators concluded that future “[p]opulation-based risk stratification schemes for COPD management should consider integrating comorbidity profiles such as those we found in this study.”
Shen E, Lee JS, Mularski RA, et al. COPD comorbidity profiles and two-year trajectory of acute and post-acute care utilization. Published online January 18, 2021. CHEST. doi:10.1016/j.chest.2021.01.020