Hospitalisations for bronchiectasis compared to COPD and asthma in the USA

Area of Science:

• Pulmonary Medicine
• Health Services Research
• Epidemiology

Background:

• Bronchiectasis, COPD, and asthma are chronic airway diseases with distinct clinical trajectories.
• Understanding differences in hospitalization outcomes is crucial for optimizing patient care and resource allocation.
• Previous research has not comprehensively compared hospitalization outcomes across these three conditions.

Purpose of the Study:

• To compare hospitalization outcomes for bronchiectasis exacerbations with those for chronic obstructive pulmonary disease (COPD) and asthma exacerbations.
• To analyze demographic factors, comorbidities, costs, length of stay, and mortality associated with these hospitalizations.
• To assess the impact of the SARS-CoV-2 pandemic on hospitalization incidence and mortality for these conditions.

Main Methods:

• A retrospective analysis of a US all-payer database from January 2017 to December 2021.
• Inclusion of hospitalizations for bronchiectasis, COPD, and asthma exacerbations.
• Statistical analysis of demographic data, hospital characteristics, comorbidities, costs, length of stay, and mortality, with adjustments for confounders.

Main Results:

• The bronchiectasis cohort (n=232,825) had longer median hospital stays (5 days) and higher median costs (USD 50,393) compared to COPD (4 days, USD 38,040) and asthma (3 days, USD 31,262).
• Adjusted analyses revealed bronchiectasis hospitalizations were 1.2 times more likely to be fatal than COPD and 3.0 times more likely than asthma (p<0.0001).
• During the pandemic (2020-2021), bronchiectasis hospitalizations decreased by 8% (vs. 26% COPD, 28% asthma), while mortality rose across all groups. Overlapping conditions did not increase mortality.

Conclusions:

• Hospitalizations for bronchiectasis in the US are associated with significantly worse outcomes compared to COPD and asthma.
• These outcomes include longer lengths of stay, higher healthcare costs, and increased mortality rates.
• Findings underscore the need for targeted clinical strategies and resource management for bronchiectasis exacerbations.