Trends in acute exacerbation and related hospitalization among COPD patients in the UK (2005-2013)

Date of ISAC Approval: 
21/05/2018
Lay Summary: 
Chronic obstructive pulmonary disease (COPD) is responsible for the deaths and disabilities of approximately 3.2 million individuals all over the world. It is estimated that by the year 2030 COPD will be the third highest cause of mortality up from its current fourth place. Smoking is primarily responsible for this highly debilitating disease. In England there are 7.3 million adult smokers and over 200 people die daily from smoking related illness which could have been prevented. Over 140,000 hospital admissions in the UK is due to COPD. A large proportion of deaths and disabilities is related to exacerbations. Acute exacerbation is the sudden worsening of symptoms in leading to difficulty in breathing, infections etc. in COPD patients. These events can lead to hospitalizations, which in turn increase healthcare expenditure. Understanding trends in exacerbations and related hospitalization can give attention to subgroups most affected by COPD within the UK, allow comparison between countries to aid healthcare planning, policy and provide a basis for improving management in the future. The aim of this study is to identify changes in COPD exacerbation and COPD hospitalization/ accident and emergency (A&E) visit from 2005 to 2013.
Technical Summary: 
Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality worldwide, causing approximately 3.2 million deaths annually. The disease is characterised by the presence of persistent airflow limitation, resulting primarily from proximal, peripheral airway and lung parenchyma obliteration. It is projected that by the year 2030 COPD will be the third highest cause of death globally. While smoking remains the major risk factor for the development of COPD, other factors include genetics and lifestyle. In the UK, mortality has increased from 2004-2012 while incidence decreased and then remained stable over the same period. There are over a million bed days and 140,000 hospital admissions each year in the UK due to COPD. A considerable amount of the burden from COPD is due to acute exacerbations of COPD (AECOPD), defined as short periods of increased cough, dyspnoea, and sputum production. Understanding trends in exacerbations and related hospitalization can help redirect healthcare policies and interventions to subgroups most affected by COPD, allow comparison between countries to aid healthcare planning, predict future healthcare challenges, and provide a basis for improving management in the future. As such it's important to understand the trends in acute exacerbation of COPD and hospitalization/A&E visits for COPD. We will select all patients aged >40 years with a read code diagnosis of COPD within the UK general practice. The date of the first COPD diagnosis will be the index date. The study will be from 1st January 2005 until December 2013, corresponding to the period since the introduction of the Quality and Outcomes Framework (QOF). We will exclude all patients with a history of asthma from the study. Patients will be followed from the index date up to the date of death, end of data collection, or end of study period, whichever comes first. For all patients at risk of the outcome of interest, the incidence rate will be the sum of all events per year divided by the total person-time at risk for each calendar year. We will stratify the incidence rates by age and gender. All analysis will be carried out using SAS 9.4.
Health Outcomes to be Measured: 
Acute exacerbations of COPD COPD Hospitalisation
Collaborators: 

Frank De Vries - Chief Investigator - Utrecht University
Anthonius de Boer - Collaborator - Utrecht University
Frank De Vries - Corresponding Applicant - Utrecht University
Frits Franssen - Collaborator - CIRO
Johanna Annemariek Driessen - Collaborator - Utrecht University
Miel (Emiel) Wouters - Collaborator - CIRO
Olorunfemi Oshagbemi - Collaborator - Utrecht University
Rachel Jordan - Collaborator - University of Birmingham
Spencer Keene - Collaborator - University of Birmingham

Linkages: 
Primary Care Vision