OBJECTIVES: The objective of this study is to characterize Veterans Affairs (VA) patients with moderate-severe COPD in terms of comorbidities, healthcare resource utilization (HRU) and mortality rate.

METHODS: From the VA health administrative data, we identified patients with ICD9/10-CM COPD diagnoses (≥1 inpatient or ≥2 outpatient visits) between January 1, 2011 and December 31, 2018. Patients were classified as moderate-severe if they were concurrently treated for ≥30 days with a long-acting muscarinic agent and a long-acting ß-agonist; the index date was the concurrent therapy initiation date. We describe the baseline demographics, comorbidities, age at diagnosis, COPD treatment history and hospitalization rate. The association with mortality was analyzed by Kaplan-Meier and Cox proportional-hazards models. Statistical significance was defined as p-value < 0.05.

RESULTS: We identified 81,851 patients (mean index age (SD): 69 years old (9.4); 97% male) with moderate-severe COPD. Two-thirds (66%) of patients reported a history of tobacco use/exposure. The most common comorbidities were hypertension (56%), dyslipidemia (46%) and ischemic heart disease (25%). Asthma was present in 13% of patients. Mean annual all-cause hospitalization rates increased from 0.2 at 5-years pre-index to 0.7 at 1-year post-index. The all-cause mortality rate 1-year post-progression was 4%. Diagnoses of metastatic cancer (hazard ratio (HR) 1.700), lung cancer (HR 1.343), heart failure (HR 1.486), HIV/AIDS (HR 1.335), chronic liver disease (HR 1.354), and peripheral vascular disease (HR 1.259) were statistically significantly associated with the highest all-cause mortality risks.

CONCLUSIONS: Our results highlight the high comorbidity burden of patients with moderate-severe COPD in the VA; most of the comorbidities are associated with an increased mortality risk. Hospitalization rate continues to increase even after the patients are started on additional COPD therapy.