Impact of moderate and severe exacerbations on clinical prognosis and economic burden of chronic obstructive pulmonary disease in China

Different severity of exacerbations of chronic obstructive pulmonary disease (AECOPD) will lead to different disease progression and economic burden. This study aimed to evaluate the impact of the severity of AECOPD on disease burden. Data were from the Tianjin Urban Employee Basic Medical Insurance Database (2016-2020). COPD patients were stratified by severity of AECOPD: (A) no AECOPD, (B) moderate AECOPD only; and (C) ≥1 severe AECOPD. Key outcomes included rate of AECOPD, mortality, COPD-related cost. Sensitivity analysis of reducing the impact of COVID-19 in outcomes were conducted. 6738 patients were identified, with 22.5% for Group A, 41.1% for Group B and 36.4% for Group C. During 1st follow-up year, Group C experienced an average of 1.43 severe AECOPD, leading to a notably increased all-cause mortality (Group C vs A-B: 17.7% vs. 2.6-3.4%, p < 0.001), highest COPD-related costs (CNY 30,245 vs 1,700-6,923). In the second year, patients in Group C still had a highest rate of severe AECOPD (0.44 vs 0.08-0.11 vs, p < 0.001), as well as increased all-cause mortality. Severe AECOPD significantly increased mortality rates and economic burden in the current and subsequent year. This underscored the imperative need to enhance severe AECOPD management.