OBJECTIVES : The asthma-COPD overlapping syndrome (ACO) became a risk factor for asthma population. However, little is known about its effect on healthcare utilizations. The objective of this study aims to investigate how ACO was associated with healthcare utilizations among asthma population. This study will justify any future treatment focus on ACO patient group.

METHODS : We conducted a pooled cross-sectional statistical analysis using the 2012-2015 National Health Interview Survey (NHIS) data, which is a nationally representative cross-sectional survey dataset. We focused on adults who had ever asthma excluding women with pregnancy. We employed an adjusted logit regression model, where the primary outcomes were dichotomous indicators on healthcare utilizations including emergency department (ED) visit, and hospital overnight stay. A key covariate is a three-category variable of asthma disease status: 1) no asthma currently but had before (reference group), 2) currently had asthma only, and 3) currently had ACO. Other covariates included age, gender, race, marital status, education level, smoking status, income level, health insurance plan, obesity status, region, and year.

RESULTS : The unweighted (weighted) sample sizes were 85,495 (14 millions). Adults with ACO were 150% more likely to have both of ED visit and hospital stay than the reference group, respectively while adults with asthma only were 50% and 20% more likely to have ED visit and hospital stay than the reference group, respectively. For a subgroup analysis (among adults with asthma currently), adults with ACO were 70% and 120% more likely to have ED visit and hospital stay than those with asthma only. In addition, adults with ACO were 70% and 140% more likely to have asthma attack and asthma-related ED visit than those with asthma only.

CONCLUSIONS : ACO was a considerable risk factor for healthcare utilizations among asthma population. More care should be considered for ACO patient group in order to reduce healthcare utilizations.