Annual hospital admissions for chronic obstructive pulmonary disease (COPD) in Canada have increased 69 per cent since 2002, especially in women and people under age 65, according to new UBC research in the Canadian Medical Association Journal.
COPD is a progressive lung disease characterized by persistent airflow limitation that makes it difficult to breathe, resulting in frequent hospitalization, burdening patients, families and health care systems. It has been viewed as a condition usually associated with male smokers.
“With increasing pressure on Canada’s health systems, it is crucial to identify gaps in care that lead to higher utilization,” said Dr. Kate Johnson, assistant professor in UBC’s Faculty of Medicine (Division of Respiratory Medicine) and the Faculty of Pharmaceutical Sciences. “Hospital admissions for COPD may represent one such area for improvement as, in many instances, they could be avoided with proper preventive or early therapeutic interventions.”
For the study, the research team from UBC, Providence Health Care Research Institute and St. Paul’s Hospital looked at national data to understand trends in admissions for COPD. They identified more than 1.1 million admissions for COPD between 2002 and 2017. Of the total admissions, 21.2 per cent were for younger adults aged 40 to 64 years and more than half in this age group were women. Over the 16-year study period, the number of annual hospital admissions for COPD increased by 68.8 per cent, from 52,937 to 89,384.
After adjusting for population growth, age and sex, the hospital admission rate for COPD increased almost 10 per cent (from 437 to 479 per 100,000 people), even though admission rates for other health concerns decreased over the same period. The increase was most pronounced among younger women (12.2 per cent), younger men (24.4 per cent) and older women (29.8 per cent), while admissions among older men declined (9.0 per cent).
“The number of hospital admissions for COPD has rapidly increased since 2010 in Canada. Even after adjusting for population growth and aging, COPD admission rates have risen since 2010 in all groups except among older males. This is in contrast to declining all-cause admission rates over this period. Our findings call into question whether progress is being made in improving COPD care and outcomes,” concluded first authors Dr. Joseph Amegadzie, a post-doctoral fellow at UBC, and Tae Yoon Lee, a PhD candidate at UBC.
The researchers say that a number of factors could be driving the increase, including better treatments that are extending the lifespans of patients with COPD, changes in the rates of pneumonia and influenza, and changes to hospital admissions practices. Environmental factors, such as changes in exposure to air pollution, wildfire smoke or indoor toxic inhalants, may also be contributing to the increase.
To help hospitals and policymakers understand the rates of COPD admissions, the research team created a web app that breaks down the data on a province-by-province basis and helps visualize key trends.
A related commentary published in CMAJ alongside the study emphasizes that the findings should sound alarm bells for health systems.
“As the prevalence of COPD in Canada’s populations rises, so too will the burden on hospitals if a radical change in COPD care is not implemented,” write Drs. Alina Blazer and Matthew Stanbrook, respirologists at the University of Toronto. “Solutions will require novel and multifactorial approaches to examining emerging risk factors for COPD, addressing disparities in gender and socioeconomic status, facilitating access to specialist care and investing resources in prevention and rehabilitation. Without sustained and coordinated action, health systems will continue to fail patients with COPD in Canada.”