Limits...
Incidence of utilization- and symptom-defined COPD exacerbations in hospital- and population-recruited patients

View Article: PubMed Central - PubMed

ABSTRACT

Objectives: The objectives of this study were to estimate the impact of recruitment source and outcome definition on the incidence of acute exacerbations of COPD (AECOPD) and explore possible predictors of AECOPD.

Patients and methods: During a 1-year follow-up, we performed a baseline visit and four telephone interviews of 81 COPD patients and 132 controls recruited from a population-based survey and 205 hospital-recruited COPD patients. Both a definition based on health care utilization and a symptom-based definition of AECOPD were applied. For multivariate analyses, we chose a negative binomial regression model.

Results: COPD patients from the population- and hospital-based samples experienced on average 0.4 utilization-defined and 2.9 symptom-defined versus 1.0 and 5.9 annual exacerbations, respectively. The incidence rate ratios for utilization-defined AECOPD were 2.45 (95% CI 1.22–4.95), 3.43 (95% CI 1.59–7.38), and 5.67 (95% CI 2.58–12.48) with Global Initiative on Obstructive Lung Disease spirometric stages II, III, and IV, respectively. The corresponding incidence rate ratios for the symptom-based definition were 3.08 (95% CI 1.96–4.84), 3.45 (95% CI 1.92–6.18), and 4.00 (95% CI 2.09–7.66). Maintenance therapy (regular long-acting muscarinic antagonists, long-acting beta-2 agonists, inhaled corticosteroids, or theophylline) also increased the risk of AECOPD with both exacerbation definitions (incidence rate ratios 1.65 and 1.73, respectively). The risk of AECOPD was 59%–78% higher in the hospital sample than in the population sample.

Conclusion: If externally valid conclusions are to be made regarding incidence and predictors of AECOPD, studies should be based on general population samples or adjustments should be made on account of a likely higher incidence in other samples. Likewise, the effect of different AECOPD definitions should be taken into consideration.

No MeSH data available.


Related in: MedlinePlus

IRRs for COPD exacerbations when using a utilization-based and symptom-based definition.Note: Results from multivariate negative binomial regression models.Abbreviations: IRR, incidence rate ratio; gen pop, general population; GOLD, Global Initiative on Obstructive Lung Disease; yrs, years.
© Copyright Policy
Related In: Results  -  Collection

License 1 - License 2
getmorefigures.php?uid=PMC5016020&req=5

f1-copd-11-2099: IRRs for COPD exacerbations when using a utilization-based and symptom-based definition.Note: Results from multivariate negative binomial regression models.Abbreviations: IRR, incidence rate ratio; gen pop, general population; GOLD, Global Initiative on Obstructive Lung Disease; yrs, years.

Mentions: Tables S3 and S4 show the results from the bivariate and multivariate negative binomial regression analyses, including all COPD patients defined by either of the two study samples, and the results are illustrated in Figure 1.


Incidence of utilization- and symptom-defined COPD exacerbations in hospital- and population-recruited patients
IRRs for COPD exacerbations when using a utilization-based and symptom-based definition.Note: Results from multivariate negative binomial regression models.Abbreviations: IRR, incidence rate ratio; gen pop, general population; GOLD, Global Initiative on Obstructive Lung Disease; yrs, years.
© Copyright Policy
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC5016020&req=5

f1-copd-11-2099: IRRs for COPD exacerbations when using a utilization-based and symptom-based definition.Note: Results from multivariate negative binomial regression models.Abbreviations: IRR, incidence rate ratio; gen pop, general population; GOLD, Global Initiative on Obstructive Lung Disease; yrs, years.
Mentions: Tables S3 and S4 show the results from the bivariate and multivariate negative binomial regression analyses, including all COPD patients defined by either of the two study samples, and the results are illustrated in Figure 1.

View Article: PubMed Central - PubMed

ABSTRACT

Objectives: The objectives of this study were to estimate the impact of recruitment source and outcome definition on the incidence of acute exacerbations of COPD (AECOPD) and explore possible predictors of AECOPD.

Patients and methods: During a 1-year follow-up, we performed a baseline visit and four telephone interviews of 81 COPD patients and 132 controls recruited from a population-based survey and 205 hospital-recruited COPD patients. Both a definition based on health care utilization and a symptom-based definition of AECOPD were applied. For multivariate analyses, we chose a negative binomial regression model.

Results: COPD patients from the population- and hospital-based samples experienced on average 0.4 utilization-defined and 2.9 symptom-defined versus 1.0 and 5.9 annual exacerbations, respectively. The incidence rate ratios for utilization-defined AECOPD were 2.45 (95% CI 1.22–4.95), 3.43 (95% CI 1.59–7.38), and 5.67 (95% CI 2.58–12.48) with Global Initiative on Obstructive Lung Disease spirometric stages II, III, and IV, respectively. The corresponding incidence rate ratios for the symptom-based definition were 3.08 (95% CI 1.96–4.84), 3.45 (95% CI 1.92–6.18), and 4.00 (95% CI 2.09–7.66). Maintenance therapy (regular long-acting muscarinic antagonists, long-acting beta-2 agonists, inhaled corticosteroids, or theophylline) also increased the risk of AECOPD with both exacerbation definitions (incidence rate ratios 1.65 and 1.73, respectively). The risk of AECOPD was 59%–78% higher in the hospital sample than in the population sample.

Conclusion: If externally valid conclusions are to be made regarding incidence and predictors of AECOPD, studies should be based on general population samples or adjustments should be made on account of a likely higher incidence in other samples. Likewise, the effect of different AECOPD definitions should be taken into consideration.

No MeSH data available.


Related in: MedlinePlus