Risk Factors for Severe Exacerbation Occurrence Among Patients with Chronic Obstructive Pulmonary Disease with Bilevel Positive Airway Pressure Therapy: A Retrospective Claims Analysis 公开
Tellez, Daniela (Summer 2023)
Abstract
Background: Chronic obstructive pulmonary disease (COPD) exacerbations constitute a major public health and economic burden. COPD imposes heterogeneity across disease severity and treatment pathways, so exacerbation predictors may vary in subset COPD populations. Bilevel positive airway pressure (PAP) therapy reduces work of breathing and improves gas exchange in patients with COPD. Risk factors for severe exacerbations among patients with COPD using bilevel PAP therapy have not been well described. The aim of this study was to identify risk factors for severe exacerbation occurrence among COPD patients on bilevel PAP therapy.
Methods: A retrospective cohort analysis was performed on administrative claims data from patients with COPD who received a bilevel PAP device claim between 2015 and 2020. Patients were tracked 1 year prior to bilevel PAP initiation (baseline), and 1 year post bilevel PAP initiation (follow-up), for a total of 2 years per patient. A modified Poisson regression model was built to identify predictors for severe exacerbation occurrence in the year following bilevel PAP initiation. Relative risks for significant predictors were then estimated, which included baseline comorbidities and demographic factors.
Results: A total of 26,465 patients with COPD and a bilevel PAP device claim were included in the analysis (mean age 61.5±10.1 SD, 46.1% female). Most patients (90.66%) had comorbid obstructive sleep apnea (OSA). Data showed that 11.52% patients experienced one or more severe exacerbations during baseline, while 6.68% did during follow-up. Severe exacerbation occurrence at baseline was associated with a nearly quintupled increased risk for severe exacerbation occurrence at follow-up [RR, 4.86; 95% CI (4.39, 5.37), P value <.0001]. Moreover, a diagnosis of OSA was associated with decreased risk of severe exacerbation occurrence [RR, 0.77; 95% CI (0.69, 0.86), P value <.0001], likely because bilevel PAP was treating apnea events and may have helped to alleviate COPD symptoms.
Conclusion: Preventing severe exacerbations from first occurring may prevent future severe exacerbations among these patients. Importantly, findings showed that treating OSA with bilevel PAP among patients with COPD was significantly associated with reduced exacerbation risk, which may encourage screening and treatment of sleep apnea in the COPD population.
Table of Contents
Table of Contents
CHAPTER 1: BACKGROUND LITERATURE REVIEW
Burden of COPD
Problem Statement
COPD Pathophysiology
Indications for Bilevel PAP in COPD
Clinical Evidence of Bilevel PAP in COPD
PAP Therapy for OSA and Overlap Syndrome
COPD Exacerbation Risk Factors
Rationale for the Research Question
CHAPTER 2: JOURNAL ARTICLE MANUSCRIPT
Background
Research Question
Study Design and Methods
Data Source
Study Population
Outcomes
Covariates
Statistical Analysis
Results
Study Population
Bilevel PAP Impact
Model Assessment
Adjusted Risk Estimates
Discussion
Strengths
Limitations
Interpretation
TABLES AND FIGURES
Figure 1- Patient Identification Period
Figure 2 - Consort Diagram
Table 1] Baseline Characteristics of COPD Patients on a Bilevel PAP Device (N=26,465)
Figure 3 - Distribution of Severe Exacerbations at Baseline and Follow-up.
Figure 4 - Distribution of Severe Exacerbations as a Binary Outcome
Table 2] Unadjusted Risk Ratios for Severe Exacerbation Occurrence at Follow-up.
Table 3] Selected Model GEE Parameter Estimates from Stepwise Regression (N=26,465)
Table 4] Adjusted Risk Ratios for Severe Exacerbation Occurrence After Model Selection (N=26,465)
Table 5] Risk Ratios for Severe Exacerbation Occurrence in Selected Model Predictors
Figure 5 - Adjusted Risk Ratios for Severe Exacerbation Occurrence
CHAPTER 3: PUBLIC HEALTH IMPLICATIONS
REFERENCES
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Risk Factors for Severe Exacerbation Occurrence Among Patients with Chronic Obstructive Pulmonary Disease with Bilevel Positive Airway Pressure Therapy: A Retrospective Claims Analysis () | 2023-07-21 18:38:35 -0400 |
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