While hospitalizations for asthma and COPD exacerbations decreased, mortality for this condition significantly increased among adults in southern Thailand from 2017 through 2021, according to study findings published in the Chinese Medical Sciences Journal.
A lack of data exists for in-hospital outcomes in Thailand for adults hospitalized with asthma and COPD exacerbations during the COVID-19 pandemic. Investigators therefore aimed to describe longitudinal in-hospital trends in mortality rates, lengths of stay (LOS), and reimbursement of medical expenses among adult patients in southern Thailand hospitalized for exacerbations of asthma and COPD.
The investigators conducted a retrospective population-based study using the National Health Security Office database, which includes about 3 million inhabitants in 7 southern Thailand provinces. ICD-10 codes were used to identify more than 19,000 adult hospitalizations for asthma (41% aged 41 to 60 years; 78% women) and more than 66,000 adult hospitalizations for COPD (47% aged 61 to 75 years; 22% women) from October 2017 through September 2021. All participants were at least 16 years of age.
The investigators noted a significant reduction in hospital admissions for asthma and COPD exacerbations over time. The asthma hospitalization rate declined from 145/100,000 population to 95/100,000. The COPD hospitalization rate declined from 487/100,000 in 2017 to 340/100,000 in 2021, (all P <.05). About 30% of patients with asthma were discharged after 1 day. About 26% of patients with COPD were discharged within 2 days.
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We have identified a trend of rising in-hospital mortality rates in patients admitted for exacerbations of asthma and COPD, despite a significant decline in the total number of exacerbation-related hospital admissions for asthma and COPD, particularly during the COVID-19 pandemic.
For patients with asthma, the in-hospital mortality rate rose from 3.2/1000 admissions in 2017 to 3.7/1000 admissions in 2021. In the same time frame, in-hospital mortality rates for COPD admissions declined from 20.3 deaths/1000 admissions in 2017 to 16.4 deaths/1000 admissions in 2020, and then increased in 2021 to 21.8 deaths/1000 admissions (all P <.05).
Increasing age was the primary contributor to the higher mortality rate, according to the investigators. Among patients over 75 years of age, asthma-related mortality nearly doubled from 10.6/1000 admissions in 2020 to 19.2/1000 admissions in 2021.
Across the study period, average LOS decreased slightly for both asthma and COPD, although total reimbursed expenses for asthma and COPD exacerbations per hospitalization rose significantly each year, particularly from 2020 to 2021.
Study limitations include uncorroborated findings and potential misidentification of asthma and COPD using ICD-10 codes.
“We have identified a trend of rising in-hospital mortality rates in patients admitted for exacerbations of asthma and COPD, despite a significant decline in the total number of exacerbation-related hospital admissions for asthma and COPD, particularly during the COVID-19 pandemic,” the investigators concluded.
