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TOPLINE:

Socioeconomic factors, including education and employment status, along with clinical parameters, such as modified Medical Research Council (mMRC) dyspnea scale and Charlson Comorbidity Index (CCI) scores, were linked to longer in-hospital stays among patients with chronic obstructive pulmonary disease (COPD).

METHODOLOGY:

• Researchers conducted the post hoc analyses of a multicenter randomized trial to examine the association of clinical, demographic, and socioeconomic characteristics of patients with COPD-specific hospital stay, all-cause hospital stay, and all-cause mortality.
• They included 1145 patients with COPD (median age, 67 years; 71% men) who had moderate-to-very severe airflow limitation and a history of current or past smoking.
• Patients underwent assessments every 6 months using the mMRC dyspnea scale and the 6-minute walk test (6MWT) over a median follow-up duration of 3 years.

TAKEAWAY:

• The risk for all-cause mortality increased with each one-point increase in mMRC dyspnea scale (hazard ratio [HR], 1.5; 95% CI, 1.22-1.85) and CCI (HR, 1.4; 95% CI, 1.20-1.62) scores.
• Each one-point increase in the mMRC dyspnea scale score was associated with a 64% increase in COPD-specific in-hospital days (95% CI, 1.36-1.98), whereas each 50-meter improvement in the 6MWT corresponded to a 6% decrease in-hospital days (95% CI, 0.89-0.99).
• Likewise, socioeconomic factors associated with longer COPD-specific in-hospital stays included low education (≤ 8 years of schooling) and unemployment (due retirement or medical reasons). Married patients had slightly fewer hospital days than singles.
• Extended all-cause in-hospital stays were associated with older age, unemployment, a one-point increase in the mMRC dyspnea scale score, and the presence of comorbidities.

IN PRACTICE:

“We suggest that health caregivers would stratify COPD patients according to their risk profile, including predictors such as smoking, unemployment, and family support and provide interventions (eg, telecommunication, education, reduction of smoking, and environmental exposures) to reduce the risks for poor disease outcomes,” the authors wrote.

SOURCE:

This study was led by Dekel Shlomi, The Adelson School of Medicine, Ariel University in Ariel and Pulmonary Clinic, Clalit Health Services Community Division in Ramat Gan, Israel. It was published online on June 29, 2025, in Chronic Respiratory Disease.

LIMITATIONS:

Although the analysis used systematically collected clinical trial data, its post hoc nature limited causal interpretations. The sample size was chosen to provide statistical power for testing the original trial’s objective and may be insufficient to detect associations with a larger set of predictors.

DISCLOSURES:

The Medical Research Infrastructure Development and Health Services Fund by the Sheba Medical Center in Ramat Gan provided support for the original COPD-community disease management clinical trial. No conflicts of interest were reported. 

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.