The Impact of COPD Type 2 Inflammation and the Consequences on Outcomes in the Brazilian Private Healthcare System: A Real-World Analysis

OBJECTIVES: Chronic obstructive pulmonary disease (COPD) significantly impacts morbidity and mortality worldwide, being one of the leading causes of death in Brazil. Elevated level of eosinophils serves as a biomarker for type 2 inflammation (T2I) and may influence exacerbation risk and lung function impairment. This study aimed to explore the burden of COPD T2I in COPD patients with high blood eosinophil count (≥300/µL; High-EOS).

METHODS: This retrospective cohort study utilized the TriNetX real-world database. Eligible participants were Brazilian adults (≥40 years) with documented COPD (ICD-10 codes J41 to J44) and eosinophil counts ≥300/µL. Patients with secondary ICD-10 codes known to increase eosinophil level were excluded.

The assessment included demographics, comorbidities, risk of outpatient visits, emergency room (ER) visits, hospitalization, and mortality from the perspective of private healthcare providers in Brazil (time horizon for 95% of facts: January 2016 to April 2024).

RESULTS: Among 10.4M individuals with documented ICD-10 codes in the Brazilian TriNetX network, 4.6M were aged ≥40 years. Of these, 19,540 had COPD-related claims, with 8,200 having eosinophils lab results within 6 months before or after any COPD-related instance.

The cohort analyzed included 5,280 individuals, averaging 3.48 ± 3.71 eosinophils/100 leukocytes in blood, with an average age of 72.7 ± 11.6 and 52% male. Major comorbidities included cardiovascular (46%), digestive (22%), and genitourinary (22%), and neoplasms (19%).

During the first-year post index, these patients had a 56% risk of ambulatory visits, 38% ER visits, 39% hospitalization, and 11% risk of mortality. From 1-day post index to end of follow-up, risks were 65% for ambulatory visits, 51% for ED visits, 53% for hospitalization, and a mortality risk of 19%.

CONCLUSIONS: COPD patients with high blood eosinophil count (≥300/µL) face significant unmet medical needs. Effective management strategies must address their heightened risks of ambulatory visits, ER visits, hospitalizations, and mortality.