C57-04 The Pandemic Paradox: A 44% Decline in COPD Hospitalizations During Covid-19 and Implications for Respiratory Healthcare Delivery

Rationale COPD remains a major cause of hospitalization among older adults. The COVID-19 pandemic significantly changed healthcare utilization patterns. We hypothesized that, understanding temporal changes in COPD hospitalizations during this period would reveal critical insights into respiratory disease management, preventable healthcare utilization and potentially identify protective factors. Methods We analyzed Centers for Medicare & Medicaid Services Part A Claims Data examining age-adjusted COPD hospitalization rates (principal diagnosis) among Medicare beneficiaries aged ≥65 years across all 50 states, District of Columbia, and Puerto Rico from 2019-2021. Primary outcomes included year-over-year changes in hospitalization rates and geographic variation. Statistical analyses included paired t-tests and Cohen’s d effect size calculations. Rates were age-adjusted using standard CMS methodology to account for demographic differences. Results National COPD hospitalization rates demonstrated a dramatic 43.5% reduction from 9.05 per 1,000 Medicare beneficiaries in 2019 to 5.11 per 1,000 in 2021. The most substantial decline occurred 2019-2020 (-39.9%), with continued decrease in 2020-2021 (-6.1%). All 51 states/territories showed reductions (paired t-test: p < 0.001, Cohen’s d = 2.36—large effect size). State-level changes ranged from -26.2% (Utah) to -56.3% (Alaska), median -44.0%. Five states achieved >50% reductions (Alaska, Delaware, Nebraska, California, Oregon), while 33 states demonstrated 40-50% reductions. Mean state rate declined from 8.04 to 4.57 per 1,000, representing compression toward lower hospitalization levels. Conclusions This unprecedented 44% decline in COPD hospitalizations during COVID-19 represents a paradoxical improvement during a respiratory pandemic. Potential mechanisms include enhanced infection control (masking, distancing—nearly eliminating influenza circulation), telemedicine expansion improving access to timely management, improved medication adherence, reduced environmental exposures (air pollution, occupational irritants), and behavioral modifications. The sustained reduction through 2021 and universality across all 51 states (large effect size d = 2.36) suggest fundamental shifts in COPD care delivery rather than temporary effects. These findings have profound implications for future respiratory healthcare delivery models. Opportunities exist to maintain lower hospitalization rates through targeted interventions: continued telemedicine integration, enhanced infection prevention education, expanded vaccination access, strengthened outpatient management programs, COPD action plans for patient self-management, and air quality improvement initiatives. Future research must identify specific modifiable factors driving these reductions to develop evidence-based strategies sustaining improved outcomes post-pandemic This abstract is funded by: None