Background: A global reduction in hospital admissions for acute exacerbations of chronic obstructive pulmonary disease (AECOPD) was observed during the first months of the COVID-pandemic. Large-scale studies covering the entire pandemic period are lacking. We investigated hospitalizations for AECOPD and the associated in-hospital mortality at the national level in France during the first years of the pandemic.Methods: We used the French National Hospital Database to analyse the time trends in ( ) monthly incidences of hospitalizations for AECOPD, considering intensive care unit (ICU) admission and COVID-diagnoses, and ( ) the related in-hospital mortality, from January to November . Pandemic years were compared with the pre-pandemic years using Poisson regressions.Results: The database included , hospitalizations for AECOPD during the study period. The median age at admission was years (interquartile range -), and % of the stays concerned women. We found: ( ) a dramatic and sustainable decline in hospitalizations for AECOPD over the pandemic period (from , to , monthly admissions, relative risk (RR) . , % confidence interval (CI) . -. ), and ( ) a concomitant increase in in-hospital mortality for AECOPD stays (from . to . % per month, RR . , % CI . -. ). The proportion of stays yielding ICU admission was similar in the pre-pandemic and pandemic years, . and . %, respectively. In-hospital mortality increased to a greater extent for stays without ICU admission (RR . , % CI . -. ) than for those with ICU admission (RR . , % CI . -. ). Since January , only . % of stays were associated with a diagnosis of COVID-, and their mortality rate was nearly three-times higher than those without COVID-(RR . , % CI . -. ).

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Background: A global reduction in hospital admissions for acute exacerbations of chronic obstructive pulmonary disease (AECOPD) was observed during the first months of the COVID-19 pandemic. Large-scale studies covering the entire pandemic period are lacking. We investigated hospitalizations for AECOPD and the associated in-hospital mortality at the national level in France during the first two years of the pandemic. Methods: We used the French National Hospital Database to analyse the time trends in (1) monthly incidences of hospitalizations for AECOPD, considering intensive care unit (ICU) admission and COVID-19 diagnoses, and (2) the related in-hospital mortality, from January 2016 to November 2021. Pandemic years were compared with the pre-pandemic years using Poisson regressions. Results: The database included 565,890 hospitalizations for AECOPD during the study period. The median age at admission was 74 years (interquartile range 65-83), and 37% of the stays concerned women. We found: (1) a dramatic and sustainable decline in hospitalizations for AECOPD over the pandemic period (from 8,899 to 6,032 monthly admissions, relative risk (RR) 0.65, 95% confidence interval (CI) 0.65-0.66), and (2) a concomitant increase in in-hospital mortality for AECOPD stays (from 6.2% to 7.6% per month, RR 1.24, 95% CI 1.21-1.27). The proportion of stays yielding ICU admission was similar in the pre-pandemic and pandemic years, 21.5% and 21.3%, respectively. In-hospital mortality increased to a greater extent for stays without ICU admission (RR 1.39, 95% CI 1.35-1.43) than for those with ICU admission (RR 1.09, 95% CI 1.05-1.13). Since January 2020, only 1.5% of stays were associated with a diagnosis of COVID-19, and their mortality rate was nearly 3-times higher than those without COVID-19 (RR 2.66, 95% CI 2.41-2.93). Conclusion: The decline in admissions for AECOPD during the pandemic could be attributed to a decrease in the incidence of exacerbations for COPD patients and/or to a possible shift from hospital to community care. The rise in in-hospital mortality is partially explained by COVID-19, and could be related to restricted access to ICUs for some patients and/or to greater proportions of severe cases among the patients hospitalized during the pandemic.