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

Abstract 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