Increase in admission threshold explains decreasing rates of hospitalisation with chronic obstructive pulmonary disease

Activity: Talks and presentationsTalks and presentations in private or public companies


Aim: Aging populations increase the use of health care resources for chronic diseases. Various initiatives are made to transfer care for
chronic diseases from secondary to primary care, but transfers of specific areas of chronic care between sectors has rarely been
documented at a national level. This study aims to investigate whether any changes could be observed in the threshold for hospitalisation
with acute exacerbation of chronic obstructive pulmonary disease (COPD) in a public paid health care system in the period 2002 to 2008.
Setting: Denmark (population 5.43 million in 2008). Design: Time trend analysis using national registers. All subjects hospitalised with
COPD between January 1994 and December 2008 were identified, and individual records of hospitalisations, migrations and death were
retrieved. Trends in incidence and severity of first-time COPD hospitalisations were analysed. Results: Both the total number of COPD
hospitalisations and the age- and sex-adjusted incidence rate of first-time COPD hospitalisations decreased; incidence rate ratio between
2002 and 2008 was 0.92 (95% confidence interval 0.89 to 0.95). Age- and sex-adjusted severity of first-time COPD hospitalisations
increased significantly: In-hospital mortality (OR 1.16), one year mortality (OR 1.12), use of intensive care unit (OR 1.42), and Charlson
comorbidity index increased by 34% Average length of stay decreased significantly from 8.8 days in 2002 to 8.4 days in 2008.
Conclusion: The severity of cases hospitalised with COPD increased considerably, while the rate and duration of hospitalisations
decreased. This leads to the conclusions that the admission threshold for COPD increases, and that more acute exacerbations are kept in
primary care treatment.
Period15. Jun 2011
Event title17th Nordic Congress of General Practice
Event typeConference
Conference number17
LocationTromsø, NorwayShow on map