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Varied regional rates of chronic obstructive pulmonary disease episodes may be due to medical system factors

Patients with chronic bronchitis and/or emphysema have lungs that become inflamed and often filled with mucus. Over time, airflow becomes obstructed and these patients are said to have chronic obstructive pulmonary disease (COPD). Patients suffering from COPD often experience frightening breathing crises that land them in the doctor's office or emergency room. The varied regional rates of these breathing crises—COPD exacerbations—may be due to health care provider and other medical system factors, suggests a new study.

Researchers at the Northwestern University Feinberg School of Medicine compared COPD exacerbation rates by Veterans Health Administration (VA) regions within the Veterans Integrated Service Network (VISN). They used hospital, outpatient, and pharmacy data on patients diagnosed with COPD from October 1999 to September 2000, who were followed until September 2002. Average COPD episode rates among the 198,981 patients (78 percent were over 60 years of age) was 0.503 events per person per year.

In the followup period, 44 percent of the patients suffered an episode of worsened COPD. During followup, the average exacerbation rate was 0.589 per person per year. However, across the VA system, there was more than a twofold difference in exacerbation rates between VISN 1 in New England and VISN 9 in Tennessee and Kentucky (0.335 vs. 0.749 episodes per person per year), even after controlling for factors associated with COPD exacerbations such as age and other illnesses. Regional variation in influenza vaccination or treatment for COPD (use of long-acting cholinergics, long-acting beta agonists, and inhaled corticosteroids) could affect COPD exacerbation rates and account for the observed regional differences, note the researchers. Their study was supported in part by the Agency for Healthcare Research and Quality (T32 HS00078).

See "Geographic variation in chronic obstructive pulmonary disease exacerbation rates," by Min J. Joo, M.D., M.P.H., Todd A. Lee, Pharm.D., Ph.D., and Kevin B. Weiss, M.D., M.P.H., in the November 2007 Journal of General Internal Medicine 22(11), pp. 1560-1565.

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