Gender Differences in the Outcomes of Patients Hospitalized for COPD: A Nationwide Analysis

SESSION TITLE: COPD 3 SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, November 1, 2017 at 01:30 PM - 02:30 PM PURPOSE: Chronic Obstructive Pulmonary Disease (COPD) affects over 30 million individuals in the United States. Hospital admissions related to COPD exacerbations incur significant costs to the healthcare system. The aim of our study was to determine whether gender plays a role with regard to in-hospital outcomes including mortality, measures of morbidity and resource utilization in patients with COPD exacerbation. METHODS: This was a retrospective cohort study using the 2013 National Inpatient Sample (NIS), the largest publically available inpatient database in the United States. The inclusion criteria were age >18 years and an ICD-9 CM code for primary diagnosis of COPD. There were no exclusion criteria. The primary outcome was in-hospital mortality. There were two secondary outcomes: (1) morbidity, as measured by intensive care unit (ICU) admission, shock, and acute respiratory failure, and (2) resource utilization, as measured by mean length of hospital stay (LOS), total hospitalization charges, and utilization of bronchoscopy and thoracentesis. Patients were classified as either having a diagnosis of COPD or not having a diagnosis of COPD using ICD-9 CM codes. Analyses were performed by using Stata, version 13.0. Odds ratios and means were adjusted for the following confounders using multivariate regression analysis models: age, race, Charlson Comorbidity Index, primary insurance, hospital location, and hospital teaching status. RESULTS: 631,664 patients with a primary diagnosis of COPD were included in the study. The mean age was 68 years and 56% of the patients were female. The in-hospital mortality rates of female COPD patients showed a reduced adjusted mortality (OR 0.88; p=0.02), lower mean length of stay (4.16 vs 4.38 days; p<0.01), rate of thoracentesis (0.74; p<0.01), and incidence of shock of any type (OR 0.78; p=0.02) as compared with males throughout the examined time period. There was no difference between male and female COPD patients with regard to mean hospital charges ($28,871 vs $28,487; p=0.12), utilization of bronchoscopy (OR 0.90; p=0.29), ICU admission (OR 0.93; p=0.08), and acute respiratory failure (OR 1.00; p=0.91). CONCLUSIONS: Female patients admitted for COPD exacerbation had a lower mortality rate and lower length of hospital stay when compared to males. Total hospitalization charges, utilization of bronchoscopy, incidence of acute respiratory failure and need for ICU admission did not significantly differ between the sexes. CLINICAL IMPLICATIONS: Barriers to healthcare utilization vary by gender. Research will need to continue documenting such variation in order to better inform policy makers and health practitioners of potential solutions for improving health outcomes. Although the presented data does not specifically identify these elements, it informs the medical community that there is such as gap. DISCLOSURE: The following authors have nothing to disclose: Navid Gholitabar, Caroline Dooley, Syed Ahsan, Farid Gholitabar, Joseph Mathew No Product/Research Disclosure Information