Employment Status, Readmission and Mortality After Acute Exacerbation of COPD

Introduction: The understanding of whether and to what extent employment status affects readmission and mortality is limited in patients with COPD.

Aim: To explore how employment status affects readmission and mortality after first admission to the hospital with acute exacerbation of COPD (AECOPD).

Methods: This study used Danish national registry-based data. All patients admitted for the first time to the hospital between 1999 and 2014 with a diagnosis of AECOPD, age 35-59, without a previous asthma diagnosis were included in the study. Employment status effect on 30-, 90-, and 365-day readmission and mortality was examined using logistic regression, adjusting for relevant confounders.

Results: A total of 11,850 COPD patients were included in the study of which 3563 (30%) were working, 1368 (12%) unemployed, 840 (7%) on sick leave, and 6079 (51%) receiving early retirement. Patients receiving early retirement had, compared to patients working, an adjusted increased likelihood of readmission at 30, 90, and 365 days (odds ratio (OR) 1.26 (CI95% (1.06-1.49)), 1.33 (CI95% (1.16-1.53)), and 1.48 (CI95% (1.33-1.66)), respectively). An increased likelihood was also seen in unemployed at 365 days follow-up (OR 1.44 (CI95% (1.22-1.68))). Early retirement was associated with an increased mortality at 30, 90, and 365 days (OR 1.39 (CI95% (1.07-1.80)) 1.37 (CI95% (1.09-1.79)) and 1.48 (CI95% (1.25-1.75)), respectively). An increased likelihood was also seen in patients receiving sick leave (OR 1.57 (CI95% (1.21-2.04))).

Conclusion: Patients with COPD who are not working at the time of first admission have a higher likelihood of readmission and mortality.