Copd and Psychiatric Illnesses: A Study of Epedmiology and Effects on Mortality

Abstract

Chronic obstructive pulmonary disease (COPD) is a common respiratory condition that involves persistent respiratory symptoms and airflow limitation. Several studies have shown increased prevalence of psychiatric illness (PI) in patients with COPD; however, prevalence rates vary widely. Hypoxemia in COPD has been associated with increased risk of cognitive and neuropsychiatric impairment while depression was associated with lower treatment adherence in patients with COPD. Despite these associations, studies investigating the effects of PI on COPD mortality and readmission remain inconclusive. This study aims to describe the prevalence of PI in COPD and evaluate the effect of PI on in-hospital mortality and 30-day readmissions using large United States population-based dataset.METHODS: Data were abstracted from the 2010 to 2018 Nationwide Readmissions Database (NRD). Hospitalizations with a primary diagnosis of COPD were identified using Diagnosis Related Groups 190 to 192 and/or All Patients Refined-Diagnosis Related Groups 140; International Classification of Diseases-9/10-Clinical Modification codes were used to identify secondary PI diagnoses of major depression, bipolar disorder, post-traumatic stress disorder, anxiety disorder, somatoform disorder, sleeprelated disorders, eating disorders, and/or alcohol use disorder. Multivariable logistic regression models were estimated to evaluate the effect of PI on mortality and 30-day readmissions. All analyses accounted for the NRD sampling design.RESULTS: A total of 6,452,636 hospitalizations with COPD occurred between 2010 and 2018. Of these, 2,160,417 (34%) carried at least one PI diagnosis. The most prevalent PI was anxiety disorder (58%) followed by sleep-related disorders (26%), and major depression (20%); Concomitant PI was more prevalent in hospitalizations in which patients were younger, female, nicotine users, and obese (P-value <0.001).Hospitalizations with concomitant PI had higher adjusted mortality rate [adjusted odds ratio (aOR): 1.07; 95% confidence interval (CI): 1.04-1.10, P-value <0.001], as well as higher 30-day readmission rates [aOR: 1.21, 95% CI: 1.20-1.22, P-value <0.001]. CONCLUSIONS:This study demonstrates that in the United States from 2010 to 2018, approximately one-third of COPD hospitalizations have a concomitant PI that is associated with higher mortality and 30-day readmission rates.CLINICAL IMPLICATIONS: COPD patients with PI should be recognized as a vulnerable population at increased risk for inhospital mortality and 30-day readmission. Further studies are needed to develop tools and measures that help identify and screen this group of patients.