A44-14 National Trends in COPD Exacerbation Outcomes and Mortality, 2016-2021

Rationale Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are a leading cause of hospitalization, mortality, and healthcare expenditure in the U.S. Despite evolving treatment approaches, nationally representative trends in outcomes and cost remain inadequately described. Methods We conducted a retrospective cross-sectional study using the HCUP-NIS database (2016-2021), including adults ≥40 years with a COPD diagnosis (ICD-10-CM: J41-J44). Exacerbations were defined by a primary diagnosis of acute respiratory failure (J96.x) with a secondary diagnosis of COPD, excluding admissions for heart failure (I50), pneumonia (J12-J18), and COVID-19 (U07.1). Outcomes included in-hospital mortality, use of mechanical ventilation (MV) and non-invasive ventilation (NIV), length of stay (LOS), and total hospital cost (CPI-adjusted to 2025 USD). Weighted analyses and multivariable regression models adjusted for demographics, comorbidities, and hospital characteristics. Results Among 2,664,123 COPD hospitalizations, 143,054 (5.4%) met criteria for AECOPD. Exacerbation admissions had significantly higher in-hospital mortality (4.7% vs. 2.2%), MV use (10.2% vs. 2.3%), and NIV use (22.6% vs. 3.0%) compared to non-exacerbation COPD (all p < 0.001). Mortality declined from 5.1% (2016) to 4.0% (2019), while NIV use rose steadily from 20.6% to 26.7%. On adjusted analysis, AECOPD independently predicted higher mortality (aOR 2.37, 95% CI 2.31-2.44) and MV use (aOR 5.10, 95% CI 5.00-5.20). Exacerbations were associated with slightly shorter LOS (−0.04 days, p = 0.009) and lower adjusted hospital costs (−$2,281, p < 0.001). Anemia (+$6,935), atrial fibrillation (+$2,162), and obesity (+$1,846) were major cost drivers. Conclusions Hospitalizations for AECOPD remain associated with high mortality and ventilation use, though outcomes have modestly improved. Rising use of NIV reflects a shift in management. The financial burden is substantial and driven by comorbid complexity. These findings underscore the need for better outpatient management and targeted interventions to reduce exacerbation-related hospitalizations. This abstract is funded by: none