Forecasting hospitalization and emergency department visit rates for chronic obstructive pulmonary disease: a time-series analysis

Rationale — Knowing trends in and forecasting acute care hospital service utilization rates for COPD can enable healthcare providers, hospitals and healthcare decision makers to plan for the future.

Objectives — We conducted a time-series analysis using healthcare administrative data from the province of Ontario, Canada to determine previous trends in acute care hospitalization and emergency department visit rates for COPD and then to forecast future utilization rates.

Methods — Individuals aged 35 and greater with physician diagnosed COPD were identified using four universal government health administrative databases and a validated case definition. Monthly COPD hospitalization and emergency department visit rates per 1000 people with COPD were determined from 2003 to 2014 and then forecasted to 2024 using autoregressive integrated moving average (ARIMA) models.

Results — Between 2003 and 2014, COPD prevalence increased from 8.9% to 11.1%. During that time, there were 274,951 hospitalizations and 290,482 emergency department visits for COPD. After accounting for seasonality, monthly COPD hospitalization and emergency department visit rates per 1000 individuals with COPD remained stable. COPD prevalence was forecasted to increase by 12.7% (95% confidence interval [CI]: 11.4-14.1)in 2024 while monthly COPD hospitalization and emergency department visit rates per 1000 people with COPD were forecasted to remain stable at 2.7 (95% CI: 1.6-4.4) and 3.7 (95% CI: 2.3-5.6), respectively. Forecasted age and sex stratified rates were also stable.

Conclusions — COPD hospital and emergency department visit rates per 1000 people with COPD have been stable for more than a decade and are projected to remain stable in the near future. Given increasing COPD prevalence, this means notably more COPD health services use in the future.