Nationwide trends in AECOPD care in Italy before, during and after COVID-19: discrepancies between data sources and across regions.

BACKGROUND

Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are a leading cause of hospital admissions, early mortality and readmissions. Italian data are outdated and fragmented, and the impact of COVID-19 on AECOPD outcomes remains unclear.

METHODS

We conducted a nationwide descriptive analysis of aggregated administrative indicators derived from two institutional sources (SDO (Schede di Dimissione Ospedaliera) and AGENAS (Agenzia Nazionale per i Servizi Sanitari Regionali)), reporting national and regional trends in hospitalisations, 30-day postdischarge mortality and 30-day readmissions for AECOPD between 2015 and 2023. Data were compared across pre-COVID (2015-2019), COVID (2020-2021) and post-COVID (2022-2023) periods and stratified by region and health district. Analyses were descriptive and based on aggregated, standardised administrative indicators, with temporal and regional comparisons across pre-COVID, COVID and post-COVID periods.

RESULTS

AECOPD hospitalisations declined by more than 45% during 2020-2021, with only partial recovery by 2023 (-24% vs 2019). Thirty-day postdischarge mortality rose sharply during the pandemic, peaking at 13.6% in 2021 (+47% vs 2019), before returning near baseline in 2023, though excess mortality persisted in several southern regions. Thirty-day readmission rates remained stable at 12%-14% across the study period. Importantly, SDO records captured only one quarter of cases identified by AGENAS, systematically underestimating the true hospitalisation burden.

CONCLUSIONS

COVID-19 profoundly disrupted AECOPD care in Italy, exposing entrenched regional inequities and critical limitations in administrative data. These findings call for modernisation of coding systems, strengthening of community-based respiratory care and implementation of structured discharge and follow-up pathways to ensure equity and resilience in COPD management.