Multimorbidity and Acute-Care Use Among Older Decedents With Advanced Chronic Obstructive Pulmonary Disease: A Retrospective Population-Based Cohort Study.

BACKGROUND

Advanced chronic obstructive pulmonary disease (COPD) is associated with substantial multimorbidity and hospital-based care near the end of life. We described multimorbidity, acute-care utilization, and documented palliative care exposure among older decedents with advanced COPD.

METHODS

We conducted a retrospective population-based cohort study using routinely collected data from an integrated health system. The cohort included eligible decedents aged 55 years or older with advanced COPD who died during 2016-2020 and 2022-2023; 2021 was excluded because the COVID-19 pandemic disrupted usual utilization patterns. Multimorbidity was characterized using the age-adjusted Charlson Comorbidity Index (CCI), comorbidity count, and individual conditions. Outcomes included total hospital admissions, hospitalizations per patient, emergency department visits, intensive care unit days, hospitalization duration, procedure burden, and documented palliative care exposure during the final year of life.

RESULTS

The cohort included 2,261 decedents. Mean age at death was 77.75 years, mean age-adjusted CCI was 8.73, and mean comorbidity count was 4.05. A total of 9,489 hospital admissions were recorded; the mean was 4.74 hospitalizations per patient. Only 167 patients (7.4%) had documented palliative care exposure. Women were older at death, whereas men had higher mean CCI scores, comorbidity counts, and recorded procedure burden.

CONCLUSIONS

Older decedents with advanced COPD experienced substantial multimorbidity and hospital-centered acute-care use, while documented palliative care exposure was uncommon. Survival analyses by palliative care exposure were excluded because exposure timing was unavailable and fixed retrospective classification would be vulnerable to immortal-time bias.