Chest
Volume 138, Issue 4, October 2010, Pages 944-949
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Original Research
Bronchiectasis
Trends and Burden of Bronchiectasis-Associated Hospitalizations in the United States, 1993-2006

https://doi.org/10.1378/chest.10-0099Get rights and content

Background

Current data on bronchiectasis prevalence, trends, and risk factors are lacking; such data are needed to estimate the burden of disease and for improved medical care and public health resource allocation. The objective of the present study was to estimate the trends and burden of bronchiectasis-associated hospitalizations in the United States.

Methods

We extracted hospital discharge records containing International Classification of Diseases, 9th Revision, Clinical Modification codes for bronchiectasis (494, 494.0, and 494.1) as any discharge diagnosis from the State Inpatient Databases from the Agency for Healthcare Research and Quality. Discharge records were extracted for 12 states with complete and continuous reporting from 1993 to 2006.

Results

The average annual age-adjusted hospitalization rate from 1993 to 2006 was 16.5 hospitalizations per 100,000 population. From 1993 to 2006, the age-adjusted rate increased significantly, with an average annual percentage increase of 2.4% among men and 3.0% among women. Women and persons aged > 60 years had the highest rate of bronchiectasis-associated hospitalizations. The median cost for inpatient care was 7,827 US dollars (USD) (range, 13-543,914 USD).

Conclusions

The average annual age-adjusted rate of bronchiectasis-associated hospitalizations increased from 1993 to 2006. This study furthers the understanding of the impact of bronchiectasis and demonstrates the need for further research to identify risk factors and reasons for the increasing burden.

Section snippets

Data Source and Population

We extracted data from the SID, which contain record-level information on inpatient hospital discharges without patient identifiers. We extracted records for which the ICD-9-CM codes for bronchiectasis were listed as any discharge diagnosis. The ICD-9-CM codes listed as the primary discharge diagnosis code generally indicate the principal condition identified or diagnosis during hospitalization, whereas the secondary codes indicate contributing or associated (“comorbid”) conditions. These

Results

From 1993 to 2006, 258,947 bronchiectasis-associated hospitalizations were identified, of which 163,021 (63%) were among women. Overall, 181,456 (70%) were among persons aged ≥ 65 years. The median age of persons hospitalized with bronchiectasis was significantly higher in women than in men (women, 75 years; men, 71 years). For hospitalizations with bronchiectasis as the primary diagnosis from 2000 to 2006, 57% (14,735) were coded as bronchiectasis with acute exacerbation (494.1), 35% (9,142)

Discussion

To our knowledge, this is the first population-based, representative analysis of bronchiectasis-associated hospitalizations in the United States. We identified a significant increase in bronchiectasis-associated hospitalizations from 1993 to 2006 across 12 states, with the highest average annual increase of 5.7% for the period from 2001 through 2006. The overall rate of 16.5 hospitalizations per 100,000 population is very similar to the rate in Hong Kong, of 16.4 hospitalizations per 100,000

Conclusions

Bronchiectasis-associated hospitalizations increased from 1993 to 2006. The rate of bronchiectasis-associated hospitalizations increased markedly, starting around age 50, with the highest rate in the oldest age groups and in older women in particular. The increasing trend in bronchiectasis-associated hospitalizations highlights the need for further research to determine the full burden and risk factors for occurrence and progression of this debilitating disease.

Acknowledgments

Author contributions: Ms Seitz: contributed to the design of the study, data collection, and analysis of the data, and was the primary author of the manuscript.

Dr Olivier: contributed to the design of the study, analysis of the data, and editing of the manuscript.

Dr Steiner: contributed to the access to the data, data collection, and editing of the manuscript.

Mr Montes de Oca: contributed to the data collection, data management, and analysis.

Dr Holland: contributed to the design of the study

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Funding/Support: This research was supported by the Intramural Research Program of the National Institutes of Health, National Institute of Allergy and Infectious Diseases.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).

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