Comorbidities, mortality, and management of chronic obstructive pulmonary disease patients who required admissions to public hospitals in Hong Kong – computerized data collection and analysis

Hok Sum Chan,1 Fanny Wai San Ko,2 Johnny Wai Man Chan,3 Loletta Kit Ying So,4 David Chi Leung Lam,5 Veronica Lee Chan,6 Cheuk Yin Tam,7 Wai Cho Yu8 1Department of Medicine, Alice Ho Miu Ling Nethersole Hospital, 2Department of Medicine and Therapeutics, The Chinese University of Hong Kong, 3Department of Medicine, Queen Elizabeth Hospital, 4Department of Medicine, Pamela Youde Nethersole Eastern Hospital, 5Department of Medicine, Queen Mary Hospital, University of Hong Kong, 6Department of Medicine and Geriatrics, United Christian Hospital, 7Department of Medicine and Geriatrics, Tuen Mun Hospital, 8Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong Background: COPD is a common cause for hospital admission. Conventional studies of the epidemiology of COPD involved large patient number and immense resources and were difficult to be repeated. The present study aimed at assessing the utilization of a computerized data management system in the collection and analysis of the epidemiological and clinical data of a large COPD cohort in Hong Kong (HK). Patients and methods: It was a computerized, multicenter, retrospective review of the characteristics of patients discharged from medical departments of the 16 participating hospitals with the primary discharge diagnosis of COPD in 1 year (2012). Comparison was made between the different subgroups in the use of medications, ventilatory support, and other health care resources. The mortality of the subjects in different subgroups was traced up to December 31, 2014. The top 10 causes of death were analyzed. Results: In total, 9,776 subjects (82.6% men, mean age =78 years) were identified. Of the 1,918 subjects with lung function coding, 85 (4.4%), 488 (25.5%), 808 (42.1%), and 537 (28.0%) subjects had the Global Initiative for Chronic Obstructive Lung Disease (GOLD) 1, 2, 3, and 4 classes, respectively. Patients with higher GOLD classes had higher number of hospital admissions, longer hospital stay, increased usage of noninvasive mechanical ventilation (NIV), combinations of long-acting bronchodilators, and higher mortality. Of the 9,776 subjects, 2,278 (23.3%) received NIV, but invasive mechanical ventilation was uncommon (134 of 9,776 subjects [1.4%]); 4,427 (45.3%) subjects had died by the end of 2014. The top causes of death were COPD, pneumonia, lung cancer, and other malignancies. Conclusion: Patients admitted to hospitals for COPD in HK had significant comorbidities, mortality, and imposed heavy burden on health care resources. It is possible to collect and analyze data of a large COPD cohort through a computerized system. Suboptimal coding of lung function results was observed, and underutilization of long-acting bronchodilators was common. Keywords: noninvasive ventilation, medications, chronic effect of TB, GOLD classification, health care resource