OBJECTIVES: To compare the disease burden of Chronic Obstructive Pulmonary Disease (COPD) patients with different severities of acute exacerbations of COPD (AECOPD) and without AECOPD.

METHODS: Based on the Tianjin Urban Employee Basic Medical Insurance Database (2016-2020), patients with COPD-related diagnoses and over 40 years of age in 2017-2018 were identified. Patients were further stratified into patients with no AECOPD in the first year of follow-up (Category A), patients with moderate AECOPD only in the first year (Category B), and those with severe AECOPD (Category C). The outcome indicators including rates of AECOPD, all-cause mortality, COPD-related medical resource utilization and COPD-related total costs in the first and second year of follow-up were estimated and compared among three categories.

RESULTS: 6738 patients with COPD were identified, with 22.5% (N=1515) in Category A, 41.1% (N=2773) in Category B, and 36.4% (N=2450) in Category C. During the first year of follow-up, compared with Category A and B, Category C experienced greater number of severe AECOPD (0 vs 0 vs 1.43) which brought a higher all-cause mortality in Category C (2.6% vs 3.4% vs 17.7%, P<0.001). Also, the resource utilization in Category C was higher than Category A and B (all P<0.001) such as number of hospitalizations and length of hospitalization with a notably higher cost in Category C (¥1700 vs ¥6923 vs ¥30245). In the second year of follow-up, compared with Category A and B, Category C was significantly higher in number of severe AECOPD (0.08 vs 0.11 vs 0.44), all-cause mortality (2.8% vs 4.9% vs 10.5%) and cost (¥3090 vs ¥6036 vs ¥12957).

CONCLUSIONS: Severe AECOPD in China would make more severe disease burden compared with Canada and US, indicated by higher number of severe AECOPD, resource utilization and total costs.