A systematic review and meta-analysis of chronic obstructive pulmonary disease in asia: risk factors for readmission and readmission rate

BACKGROUND: Patients with chronic obstructive pulmonary disease (COPD) often require hospital readmission because of exacerbation of their condition. These frequent exacerbations reduce quality of life, work performance, and emotional health. However, few studies have investigated the risk factors for readmission and readmission rates in Asian patients with COPD. We conducted a systematic review to identify and understand the major risk factors for readmission in patients with COPD in Asia and the readmission rate. METHOD: We searched PubMed, MEDLINE, Embase, China National Knowledge Infrastructure, Wanfang Data Knowledge Service Platform, and China Biomedical Literature Database from database inception to September 2023 to identify studies on the readmission rate and risk factors for COPD in Asian patients. Chinese search terms included "COPD," "chronic obstructive pulmonary disease," "risk factors," "recurrence," "readmission," and "acute exacerbation." English search terms included "chronic obstructive pulmonary disease," "COPD," "lung emphysema," "hospital admission," "patient readmission," and "readmission." We extracted first author, publication year, research area, sample size, sex, risk factors, and readmission rates. The included studies' quality was evaluated using the Agency of Healthcare Research and Quality. Meta-synthesis was conducted on readmission rates and risk factors for readmission. Subgroups were formed by age, research area, sample size, and research type, and meta-regression analysis was conducted on the 30-day, 90-day, and 365-day readmission rates of patients to determine the source of heterogeneity. Finally, the results' robustness was evaluated using sensitivity analysis. Begg and Egger tests were used to evaluate publication bias. RESULTS: Meta-analysis of 44 studies, with 169,255 participants, indicated that risk factors for COPD readmission in Asia included: history of multiple hospital admissions, ≥ 3 comorbidities, male sex, ratio of eosinophils percentage ≥ 2%, body mass index 20, nutritional disorder, Neutrophil-to-Lymphocyte ratio > 7, and FEV1 < 50. The 30-, 90-, and 365-day readmission rates of patients were 19%, 31%, and 42%, respectively. CONCLUSIONS: Patients with COPD in Asia generally have high readmission rates and different risk factors. To reduce healthcare, economic, and social burdens, interventions should address major risk factors, early prevention, and screening.