Ten-year trends and influencing factors of hospitalization costs in chronic obstructive pulmonary disease: a quantile regression analysis (2016–2025)

Background To investigate the composition, temporal trends, and factors associated with per-admission hospitalization costs for chronic obstructive pulmonary disease (COPD)—related admissions from 2016 to 2025, adjusted for inflation and temporal effects, and to inform clinical cost control and optimized management strategies. Methods We analyzed 4,766 COPD admissions events to a tertiary hospital in Guangxi, China. Descriptive analysis characterized cost trends and composition, followed by nonparametric tests, multiple linear regression, and quantile regression to identify cost-influencing factors. Results Among the 4,766 eligible admissions, 75.9% ( n = 3,617) occurred in male patients, with a mean age at admission of 74.50 ± 9.92 years. The overall comorbidity prevalence per admission was 97.80%, showing a steady increasing annual trend. Inflation-adjusted total per-admission costs remained stable over the decade (median: 6,500.53 RMB), with drug, medical service, and diagnostic costs as the largest components. Univariate analysis showed that age, length of stay (LOS), admission route and status, discharge mode, comorbidity count, antibiotic use, surgery/invasive procedures, admission year, and specific comorbidities including hypertension, heart disease, cerebral stroke, asthma, chronic lung disease, and kidney disease were significantly associated with per-admission hospitalization costs (all P < 0.05). Multiple linear regression identified significant admission year effects (2017, 2022, 2023, and 2024 as positive predictors, and 2021 and 2025 as negative predictors), age, LOS, comorbidity count, emergency admission, critical illness, invasive procedures, and cardiac/cerebral comorbidities as significant independent predictors (adjusted R 2 = 0.703). Critically, quantile regression revealed that LOS, comorbidity count, invasive procedures, and emergency admission were associated with a more pronounced increase in costs among high-cost admissions, with regression coefficients increasing across quantiles. Conclusion Inflation-adjusted per-admission COPD hospitalization costs were stable over the decade, driven by drugs, medical services and diagnostics. Admission year, age, comorbidity count, LOS, invasive procedures and acute critical admission correlated with higher costs, with stronger associations in high-cost admissions. These findings support the development of targeted interventions for cost containment and standardized clinical management of COPD.