Exacerbations and subsequent healthcare utilization patterns among patients with chronic obstructive pulmonary disease: A real-world study using health insurance administrative databases among incident and prevalent cases in Ontario, Canada between 2004 and 2020

RATIONALE The rationale for this study is to understand how age and/or chronic obstructive pulmonary disease status (COPD; incident/prevalent) impact healthcare resource use (HCRU) and costs among individuals with a history of acute exacerbation of COPD (AECOPD).OBJECTIVE The objective of this study is to describe impact, by age group and disease status, of AECOPD on all-cause and COPD-related HCRU in Canada.METHODS Adults with COPD within Ontario health administrative insurance databases (01/2004 to 03/2020; ≥24 months continuous data availability; baseline = first 12-months; incident cases = no prior COPD-related claims) were identified. Mutually exclusive groups based on baseline frequency and severity of AECOPD were established.MEASUREMENTS The measurements used in this study were the annual HCRU and costs per person, estimated per service-type, which included emergency department (ED) and outpatient visits, inpatient admissions, and medications. Total costs included all service-types except medications. Hospitalization intensity (and severity) was based on the need for special care units (SCU).MAIN RESULTS Among adults with COPD (n = 989,243), a consistent increasing trend of HCRU and costs was observed with more severe baseline exacerbations, across all service-types and by age, with incident/prevalent COPD. Outpatient visits accounted for the majority of HCRU. When stratified by age, the notable finding was younger adults (