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Journal of Peking University (Health Sciences) ›› 2023, Vol. 55 ›› Issue (6): 1074-1081. doi: 10.19723/j.issn.1671-167X.2023.06.019

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Epidemiology and hospitalization costs analysis of female inpatients with acute exacerbation of chronic obstructive pulmonary disease in Beijing from 2013 to 2020

Zi-kai WANG1,Jia-li MO2,Meng ZHANG1,Ji-ping LIAO1,*()   

  1. 1. Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing, 100034, China
    2. Departmant of Pediatrics, Peking University First Hospital, Beijing, 100034, China
  • Received:2023-07-11 Online:2023-12-18 Published:2023-12-11
  • Contact: Ji-ping LIAO E-mail:jipingliao@hotmail.com
  • Supported by:
    Beijing Health Technologies Promotion Program(BHTPP202053);Beijing Municipal Commission of Science and Technology(Z221100007422040)

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Abstract:

Objective: To study epidemiological characteristics and hospitalization costs of female inpatients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in Beijing. Methods: A retrospective study was conducted to analyze electronic hospitalization summary reports of female inpatients with AECOPD in Beijing from 2013 to 2020. Clinical characteristics (age distribution and comorbidities), epidemiological characteristics (temporal and spatial distribution characteristics), hospi-talization times and costs of patients were described. Results: A total of 57 911 subjects in 166 hospitals were included in this study, with a mean age of (78.84±8.59) years and the highest number of patients aged 80-89 years (49.06%), followed by patients aged 70-79 years (31.08%), and the lowest number of patients under 50 years (0.41%). The proportions of patients with coronary heart disease, hypertension and heart failure were 30.60%, 30.52% and 26.54% respectively. The median number of daily hospitalizations during the study period was 18 (IQR: 16). The number of daily hospitalizations for AECOPD showed an overall growth trend over the eight years from 2013 to 2020, starting to increase significantly in 2015 and continuing to increase until 2019, then followed by a decline in 2020. The proportion of inpatient admissions was higher in winter and spring (54.09%) than that in summer and autumn (45.91%). The top three districts in terms of the proportion of total inpatient admissions were Xicheng district (14.18%), Chaoyang district (14.12%) and Fengtai district (13.47%). The density of inpatients was relatively high in the western regions, central urban areas and northeastern regions of the city, while the density of inpatients was relatively low in the near suburbs. The median number of hospital days for female patients with AECOPD was 12 days, and the median hospital costs was CNY 20 648.37. Patients from urban areas had longer hospitalization times and higher hospitalization costs than those from suburban areas (P < 0.001). Western medicine expenses accounted for the largest proportion of total hospital expenses (33.32%). During the study period, hospitalization costs exhibited an overall pattern of initial growth, followed by subsequent decline, eventually stabilizing. The differences in hospitalization costs among the patients with different comorbidities were significant. Conclusion: Female hospitalized patients with AECOPD in Beijing were older than 70 years, often complicated by cardiovascular disease. AECOPD occurred mainly in winter and spring, with regional differences. The hospitalization costs were closely associated with the patients' age, comorbidities, and the geographicical region.

Key words: Acute exacerbation of chronic obstructive pulmonary disease, Female, Hospitalization costs, Epidemiology

CLC Number: 

  • R563.9

Table 1

Clinical characteristics of total and daily hospital admissions of female patients with AECOPD in Beijing from 2013 to 2020"

Items n (%) Characteristics of daily hospital admissions
M Min Max IQR
Total 57 911(100.00) 18 1 174 16
Age/years
  18-49 237 (0.41) 1 1 3 0
  50-59 1 786 (3.08) 1 1 8 1
  60-69 5 905 (10.20) 2 1 22 2
  70-79 17 996 (31.08) 6 1 56 5
  80-89 28 413 (49.06) 9 1 75 9
  ≥90 3 574 (6.17) 2 1 12 1
Complications
  Coronary heart disease 17 723 (30.60) 6 1 56 6
  Atrial fibrillation 3 473 (6.00) 1 1 10 1
  Heart failure 15 370 (26.54) 5 1 44 5
  Hypertension 17 675 (30.52) 6 1 47 6
  Diabetes 6 643 (11.47) 2 1 16 3

Figure 1

Time series chart of daily hospital admissions of female patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in Beijing from 2013 to 2020"

Table 2

Seasonal variations of total and daily hospital admissions of female patients with AECOPD in Beijing from 2013 to 2020"

Items n (%) Characteristics of daily hospital admissions
M Min Max IQR
Spring 14 312 (24.71) 17 1 56 16
Summer 12 501 (21.59) 16 1 43 13
Autumn 14 083 (24.32) 17 1 58 16
Winter 17 015 (29.38) 22 1 174 20

Table 3

Spatial distribution of total and daily hospital admissions of female patients with AECOPD in Beijing from 2013 to 2020"

Items n (%) Characteristics of daily hospital admissions
M Min Max IQR
Urban areas
  Dongcheng 6 643 (11.47) 3 1 14 2
  Xicheng 8 212 (14.18) 3 1 13 3
  Chaoyang 8 175 (14.12) 3 1 14 2
  Haidian 5 705 (9.85) 2 1 12 2
  Fengtai 7 800 (13.47) 3 1 14 2
  Shijingshan 4 560 (7.87) 2 1 12 2
Suburban areas
  Daxing 2 060 (3.56) 1 1 22 1
  Tongzhou 1 092 (1.89) 1 1 5 0
  Shunyi 1 288 (2.22) 1 1 11 1
  Changping 1 800 (3.11) 1 1 8 1
  Mentougou 2 449 (4.23) 1 1 10 1
  Fangshan 4 244 (7.33) 2 1 33 2
  Huairou 735 (1.27) 1 1 7 0
  Pinggu 865 (1.49) 1 1 5 0
  Miyun 1 010 (1.74) 1 1 6 1
  Yanqing 1 273 (2.20) 1 1 15 1

Figure 2

Spatial distribution chart of hospitalizations density of female patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in Beijing from 2013 to 2020 (/10 000 person-years)"

Table 4

Hospitalization times and costs of female patients with AECOPD in Beijing from 2013 to 2020"

Items Hospitalization times /d, M (IQR) H/U P value Hospitalization costs /yuan, M (IQR) H/U P value
Total 12 (8) 20 648.37 (17 357.88)
Age/years 459.92 ＜0.001 1 495.66 ＜0.001
  18-49 9 (6) 13 494.52 (9 356.01)
  50-59 11 (6) 15 707.68 (11 404.33)
  60-69 13 (9) 17 048.92 (12 861.81)
  70-79 13 (6) 20 197.73 (16 160.18)
  80-89 14 (8) 22 173.09 (18 848.26)
  ≥90 12 (7) 21 754.29 (18 915.54)
With complications 99.46 ＜0.001 489.08 ＜0.001
  Yes 11 (7) 20 118.93 (15 629.94)
  No 12 (9) 21 457.84 (19 992.87)
Season 27.07 ＜0.001 6.78 0.079
  Spring 12 (8) 20 641.66 (16 961.2)
  Summer 12 (8) 20 903.46 (17 822.19)
  Autumn 12 (8) 20 503.37 (16 828.64)
  Winter 11 (8) 20 631.11 (17 683.63)
Areas 1 590.98 ＜0.001 4 358.15 ＜0.001
  Urban areas 13 (8) 22 843.59 (18 307.91)
  Suburban areas 10 (7) 15 159.72 (11 985.30)

Figure 3

Composition ratio of hospitalization costs of female patients with AECOPD in Beijing from 2013 to 2020"

Figure 4

Time distribution of hospitalization costs of female patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and different comorbidities in Beijing from 2013 to 2020"

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