Predictors of Early Readmission Among Patients Aged 40 to 64 Years Hospitalized For Chronic Obstructive Pulmonary Disease


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Rationale: Various causes can contribute to the high rates of readmissions among patients hospitalized with chronic obstructive pulmonary disease (COPD).

Objective: To determine the frequency and predictors of early readmission among patients age 40-64 years, hospitalized with COPD.

Methods: In a retrospective cohort study, using a large national commercial insurance database, we obtained the clinical information within 12 months prior to the index hospitalization and 30 days after discharge.

Measurements: Primary outcome was early readmission, defined as hospitalization within 30 days from discharge. We categorized predictor variables as patient, provider, and system factors and compared these variables between patients readmitted and those not readmitted. Logistic regression was used for multivariable analysis.

Main results: Of 8,263 patients who met the inclusion criteria, 741 (8.9%) had early readmission. Multivariable analysis showed patient factors (male sex, history of heart failure, lung cancer, osteoporosis and depression), provider factors (no prior prescription of statin within 12 months before the index hospitalization and no prescription of short-acting bronchodilator, oral steroid and antibiotic upon discharge) and system factors (length of stay <2 or >5 days and lack of follow-up visit after discharge) were associated with early readmission among patients hospitalized with COPD. C-statistics of the model including patient characteristics was 0.677 (95% Confidence Interval [CI]: 0.656-0.697), which was improved to 0.717 (95%CI: 0.702-0.732), after addition of provider- and system-based factors.

Conclusions: One in 11 patients hospitalized with COPD is readmitted within 30 days after discharge. Provider and system factors are important modifiable risk factors of early readmission.



Hospital readmission, COPD, follow-up visit