Abstract
BackgroundIdentifying clinical and socio-economic predictors of adverse health outcomes in chronic obstructive pulmonary disease (COPD) patients is imperative for reducing exacerbation and mortality rates.MethodsThe COPD Community Disease Management (COPD-CDM) clinical trial evaluated the efficacy of a disease management program among 1202 ambulatory COPD patients receiving recommended care. The study did not find disease management to be superior to recommended care only, in preventing COPD hospital admissions or mortality. This post-hoc analysis examined the association of clinical and socioeconomic parameters with the length of in-hospital stay and all-cause mortality by multivariable non-linear mixed and Cox proportional hazards models, adjusted for age, sex, study arm, recruitment and study period, and medical therapy.ResultsA one-point increment in the Modified Medical Research Council dyspnea scale was associated with a higher hazard for all-cause mortality, (Hazards Ratio [HR]:1.50, 95% confidence interval [CI]: 1.22-1.85); longer in-hospital stay for COPD or all causes; Rate Ratio (95% CI): 1.64 (1.36-1.98), and 1.36 ( 1.19-1.55), respectively. A 50 m increment in six-minute walking distance was associated with fewer days in-hospital for both COPD and all causes; Rate Ratio (95% CI); 0.94 (0.89-0.99) and 0.95 (0.92-0.99), respectively. Unemployment and lower educational attainment were associated with a longer in-hospital stay both for COPD and all causes.ConclusionsClinical and socioeconomic parameters were associated with the number of days in hospital for COPD and all-causes, and all-cause mortality in ambulatory COPD patients. Our findings support the importance of a multi-disciplinary pulmonary approach to improve clinical outcomes among COPD patients.