泰国南部因哮喘和慢性阻塞性肺疾病加重而住院的成人的院内死亡率和住院结果（2017-2021年）：基于人口的研究

doi:10.24920/004252

摘要/Abstract

摘要：

背景泰国因哮喘和慢性阻塞性肺疾病（COPD）恶化而住院的情况时有发生。住院治疗结果的全国性趋势对于医疗保健系统内预防策略的规划至关重要。本文研究了泰国南部因哮喘和COPD加重而住院的成人的住院结果的时间趋势，包括死亡率、住院时间（LOS）和报销费用。
方法利用泰国南部国家卫生安全办公室提供的数据，对因哮喘和COPD加重而住院的成人进行了一项基于人群的回顾性研究。对2017年至2021年期间分别因哮喘和COPD住院的19,459例患者和66,457患者进行了基线人口统计学和住院结果评估。
结果随着时间的推移，因哮喘和COPD加重而住院的人数显著减少，尤其是在2020/2021年。从2017年到2021年，哮喘的院内死亡率从每1,000例住院患者中有3.2例死亡上升到3.7例（P<0.05）。另一方面，COPD的入院死亡率在2017年至2020年期间从每1000例住院患者20.3例死亡降至16.4例，但随后在2021年又增至21.8例（P<0.05）。死亡率上升的主要原因是年龄的增长。不过，在研究期间，哮喘和COPD的平均住院时间都略有缩短。哮喘和CP{D每次住院的总费用显著增加，2020/2021 年的增幅尤为明显。
结论 2017-2021 年间，泰国哮喘和COPD加重继续在院内死亡率和报销费用中占据重要地位，但住院人数总体有所减少，住院时间也略有波动。

关键词: 住院, 死亡率, 加重, 泰国

Abstract:

Background Hospitalizations for asthma and chronic obstructive pulmonary disease (COPD) exacerbations frequently occur in Thailand. National trends in hospital outcomes are essential for planning preventive strategies within the healthcare system. We examined temporal trends in in-hospital outcomes, including mortality rate, length of stay (LOS), and expenses for reimbursement in adults hospitalized for asthma and COPD exacerbations in southern Thailand.
Methods A retrospective, population-based study on adults hospitalized for exacerbations of asthma and COPD was carried out using data from the National Health Security Office in southern Thailand. Baseline demographic and in-hospital outcome assessments were conducted on 19,459 and 66,457 hospitalizations for asthma and COPD, respectively, between 2017 and 2021.
Results Significant reductions in hospital admissions for exacerbations of asthma and COPD were observed over time, particularly in 2020/2021. From 2017 to 2021, the in-hospital mortality rate for asthma rose from 3.2 to 3.7 deaths per 1,000 admissions (P<0.05). The rates for COPD admissions, on the other hand, reduced from 20.3 to 16.4 deaths per 1,000 admissions between 2017 and 2020, but subsequently increased to 21.8 in 2021 (P<0.05). The prominent contributor to the higher mortality rate was found to be increasing age. Nonetheless, the average LOS for both asthma and COPD decreased slightly over the study period. The total expenses for reimbursing exacerbations of asthma and COPD per hospitalisation have risen significantly each year, with a particularly notable increase in 2020/2021.
Conclusion During 2017-2021, exacerbations of asthma and COPD in Thailand continued to account for significant in-hospital mortality rates and reimbursement expenses, despite the overall decrease in hospitalizations and slight fluctuations in the LOS.

Key words: asthma, COPD, hospitalization, mortality, exacerbation, Thailand

Narongwit Nakwan, Kanittha Suansan. In-hospital Mortality and Hospital Outcomes among Adults Hospitalized for Exacerbations of Asthma and COPD in Southern Thailand (2017-2021): A Population-Based Study[J].Chinese Medical Sciences Journal, 2023, 38(3): 228-234.

图/表 5

参考文献 22

1	Global Initiative for Asthma GINA. Global strategy for asthma management and prevention, updated 2023. Available from http://www.ginasthma.org, 2022. Accessed: November 1, 2022.
2	Global Initiative for Chronic Obstructive Lung Disease GOLD. Global strategy for prevention, diagnosis and management of copd, updated 2022. Available from https://goldcopd.org/2022-gold-report-2. Accessed: November 1, 2022.
3	Kaur BP, Lahewala S, Arora S, et al. Asthma: hospitalization trends and predictor of in-hospitality and hospitalization costs in the USA (2001-2010)[J]. Int Arch Allergy Immunol 2015; 168: 71-8. doi:10.1159/000441687.
4	Inmai PN, Liabsuetrakul T, Ichihara N, et al. Health effects of the asthma care program under the universal coverage scheme in children and young adults in Thailand[J]. Int J Environ Res Public Health. 2022; 19(7): 4130. doi:10.3390/ijerph19074130.
5	Lima FV, Yen TY, Patel JK. Trends in in-hospital outcomes among adults hospitalized with exacerbation of chronic obstructive pulmonary disease[J]. COPD 2015; 12(6): 636-42. doi:10.3109/15412555.2015.1020151. pmid: 26263035
6	Krishnan V, Diette GB, Rand CS, et al. Mortality in patients hospitalized for asthma exacerbations in the United States[J]. Am J Respir Crit Care Med. 2006; 174(6): 633-8. doi:10.1164/rccm.200601-007OC.
7	Kirenga BJ, de Jong C, Mugenyi L, et al. Rates of asthma exacerbations and mortality and associated factors in Uganda: a 2-year prospective cohort study[J]. Thorax 2018; 73(10): 983-5. doi:10.1136/thoraxjnl-2017-211157. pmid: 29752346
8	Shah SA, Quint JK, Sheikh A. Impact of COVID-19 pandemic on asthma exacerbations: retrospective cohort study of over 500,000 patients in a national English primary care database[J]. Lancet Reg Health Eur. 2022; 19: 100428 doi: 10.1016/j.lanepe.2022.100428.
9	Chan KF, Kwok WC, Ma TF, et al. Territory-wide study on hospital admissions for asthma exacerbations in the COVID-19 pandemic[J]. Ann Am Thorac Soc 2021; 18(10): 1624-33. doi:10.1513/AnnalsATS.202010-1247OC.
10	Poucineau J, Delory T, Lapidus N, et al. Hospital admissions and mortality for acute exacerbations of COPD during the COVID-19 pandemic: a nationwide study in France[J]. Front Med (Lausanne) 2022; 9: 995016. doi: 10.3389/fmed.2022.995016.
11	Alqahtani JS, Oyelade T, Aldhahir AM, et al. Reduction in hospitalised COPD exacerbations during COVID-19: a systematic review and meta-analysis[J]. PLoS One 2021; 16(8):e0255659. doi:10.1371/journal.pone.0255659.
12	Ekström M, Nwaru BI, Wiklund F, et al. Risk of rehospitalization and death in patients hospitalized due to asthma[J]. J Allergy Clin Immunol Pract 2021; 9(5): 1960-8.e4. doi:10.1016/j.jaip.2020.12.030. pmid: 33359587
13	Singanayagam A, Schembri S, Chalmers JD. Predictors of mortality in hospitalized adults with acute exacerbation of chronic obstructive pulmonary disease[J]. Ann Am Thorac Soc 2013; 10(2): 81-9. doi:10.1513/AnnalsATS.201208-043OC. pmid: 23607835
14	Sykes DL, Faruqi S, Holdsworth L, et al. Impact of COVID-19 on COPD and asthma admissions, and the pandemic from a patient’s perspective[J]. ERJ Open Res 2021; 7(1): 00822-2020. doi:10.1183/23120541.00822-2020.
15	Sunjaya AP, Allida SM, Tanna GLD, et al. Asthma and COVID-19 risk: a systematic review and meta-analysis[J]. Eur Respir J 2022; 59(3): 2101209. doi: 10.1183/13993003.01209-2021.
16	Pardhan S, Wood S, Vaughan M, et al. The Risk of COVID-19 related hospitalsation, intensive care unit admission and mortality in people with underlying asthma or COPD: a systematic review and meta-analysis[J]. Front Med (Lausanne) 2021; 8: 668808. doi: 10.3389/fmed.2021.668808.
17	Tydeman F, Pfeffer PE, Vivaldi G, et al. Rebound in asthma exacerbations following relaxation of COVID-19 restrictions: a longitudinal population-based study (COVIDENCE UK)[J]. Thorax 2023; 78(8): 752-9. doi:10.1136/thorax-2022-219591.
18	Ehteshami-Afshar S, FitzGerald JM, Doyle-Waters MM, et al. The global economic burden of asthma and chronic obstructive pulmonary disease[J]. Int J Tuberc Lung Dis 2016; 20: 11-23. doi:10.5588/ijtld.15.0472. pmid: 26688525
19	Ford ES, Murphy LB, Khavjou O, et al. Total and state-specific medical and absenteeism costs of COPD among adults aged ≥18 years in the United States for 2010 and projections through 2020[J]. Chest 2015; 147(1): 31-45. doi: 10.1378/chest.14-0972.
20	Dalal AA, Shah M, D’Souza AO, et al. Costs of COPD exacerbations in the emergency department and inpatient setting[J]. Respir Med. 2011; 105(3): 454-60. doi:10.1183/09059180.06.00009802. pmid: 20869226
21	Woo L, Smith HE, Sullivan SD. The economic burden of chronic obstructive pulmonary disease in the Asia-Pacific region: a systematic review[J]. Value Health Reg Issues 2019; 18: 121-31. doi: S2212-1099(19)30046-9 pmid: 31051330
22	Lai CKW, Kim YY, Kuo SH, et al. Cost of asthma in the Asia-Pacific region[J]. Eur Respir Rev 2006; 15 (98): 10-6. doi: 10.1183/09059180.06.00009802

Iterms	All	Asthma					All	COPD
Iterms	All	2017	2018	2019	2020	2021	All	2017	2018	2019	2020	2021
Total hospital admission (n)	19,459	4,126	4,182	4,316	3,958	2,877	66,457	14,419	14,558	14,692	12,499	10,289
Total patients admitted (n)	9,486	2,838	2,889	2,989	2,707	2,013	19,767	6,780	6,883	6,902	6,166	5,127
Age [yrs, mean (SD)]	51.8 (17.7)	51.5 (17.1)	51.4 (18.4)	51.9 (17.4)	51.5 (18.2)	52.7 (17.5)	69.5 (11.3)	69.9 (11.2)	69.5 (17.1)	69.2 (11.2)	69.2 (11.5)	69.1 (11.5)
Age group (yrs, n)
15-40	5,085	1,046	1,132	1,074	1,093	740	662	116	142	137	158	111
41-60	7,956	1,759	1,700	1,807	1,551	1,139	13,148	2,693	2,818	3,971	2,572	2,904
61-75	4,649	957	964	1,050	940	738	31,061	6,731	6,893	6,909	5,771	4,757
> 75	1,769	364	386	387	374	260	21,586	4,881	705	4,675	3,998	3,327
Gender (%)
Male	22.2	20.9	21.3	21.3	23.3	25.3	78.3	76.9	77.0	78.3	79.5	80.1
Female	77.8	79.1	78.7	78.7	76.7	74.7	21.7	23.1	23.0	21.7	20.5	29.9

Items	Average	Fiscal year
Items	Average	2017	2018	2019	2020	2021
Age-adjusted asthma hospitalization per 100,000 population	130	139	141	145	132	95
Age-adjusted asthma mortality rate per 100,000 population	0.44	0.41	0.44	0.44	0.47	0.43
Case fatality rate per 1,000 hospital admissions	3.4	3.2	2.9	3.3	3.7	3.7
15-40 years	3	4.7	1.7	4.6	0	4.1
41-60 years	3.4	1.7	2.9	1.1	2.5	8.7
61-75 years	3.8	2.1	3.1	1.9	6.3	5.4
>75 years	10.7	5.5	7.7	10.3	10.6	19.2
Length of stay [d, mean (range)]	2.77 (1-95)	2.82 (1-57)	2.82 (1-37)	2.76 (1-39)	2.68 (1-95)	2.74 (1-48)
Reimbursement per admission [Baht, mean (range)]	5,084 (963-232,454)	4,696 (963-232,454)	4,601 (1,116-209,531)	5,059 (1,089-216,163)	5,197 (1,102-216,916)	6,227 (1,254-131,309)
Total reimbursement of the year (Baht)	NA	19,368,452	19,242,761	21,835,004	20,571,843	17,916,073

Iterms	average	Fiscal year
Iterms	average	2017	2018	2019	2020	2021
Age-adjusted COPD hospitalization per 100,000 population	446	487	492	494	417	340
Age-adjusted COPD mortality rate per 100,000 population	8.3	10.2	8.7	8.8	7.2	6.6
Case fatality rate per 1,000 hospital admission	18.6	20.3	17.6	17.8	16.4	21.8
15-40 years	3.7	8.7	1.4	2.2	6.3	0
41-60 years	9.2	11.5	7.4	9.7	9.7	7.6
61-75 years	16.2	17.3	15.3	15.6	17.3	15.7
>75 years	27.9	31.5	27.4	25.8	22.5	33.1
Length of stay [d, mean (range)]	3.98 (1-228)	4.10 (1-228)	4.01 (1-200)	3.93 (1-196)	3.84 (1-186)	3.85 (1-95)
Reimbursement per admission [Baht, mean (range)]	10,045 (1,111-509,763)	9,158 (1,020-275,488)	9,537 (1,111-276,488)	10,259 (1,188-255,559)	9,868 (860-251,559)	12,148 (1,252-509,763)
Total reimbursement of the year (Baht)	NA	131,905,909	138,708,376	150,689,175	123,288,259	123,005,492

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