Chronic obstructive pulmonary disease (COPD) is a series of diseases, including chronic bronchitis and emphysema, that lead to obstructions in one’s respiratory system and, in turn, difficulty breathing (CDC). Common causes of COPD include exposure to tobacco smoke and other airborne pollutants, as well as genetic susceptibility and frequent respiratory infections (American Lung Association). COPD is characterized by shortness of breath, tightness of the chest, wheezing/coughing, and excess mucous production (CDC).
COPD is quite common within the United States, as of 2017 approximately 16.3 million (6.6%) American adults have been diagnosed with COPD and it is the 4th leading cause of death among Americans. The CDC estimated that COPD-related healthcare costs could reach as high as $49 billion in 2020, the majority (51%) of which is financed through Medicare. In this edition of Stories from the dashboard we will be investigating COPD-related emergency department visits in North Carolina and their insurance coverage using NC DETECT’s Asthma & COPD Dashboard.
Within NC DETECT, emergency department visits are classified as COPD-related if any of the patient’s ICD-10-CM diagnosis codes have to do with COPD, regardless of whether it is the primary cause of the visit. In 2020, 4.55% of ED visits in North Carolina were COPD-related (N=183,828), with visits occurring at an unadjusted rate of 175.3 per 10,000 person-years. Females presented more often than males (101,173 visits vs. 82,620 visits). Approximately 51% of all visits were individuals aged 65 years or older (N=94,142) while those under the age of 18 accounted for only 0.4% of visits.
Percentage of COPD-related emergency department visits by insurance status, North Carolina, 2020
When stratified by insurance coverage, the majority of COPD-related ED visits statewide were paid for using Medicare (52.5%). Private insurance (19.3% of visits) and Medicaid (14.1%) were also commonly utilized. About 7% of visits were paid for by the patient while 6.2% were either unknown or financed through other means. Lastly, 0.6% of visits were covered through worker’s compensation. In the majority of North Carolina’s counties, Medicare was the most commonly utilized type of coverage. Patients in counties in which Medicare was not the most utilized coverage type most commonly utilized private insurance.
These results are consistent with the broader distribution of insurance coverage among North Carolinians. Using data from the American Community Survey, the Kaiser Family Fund reports that approximately 11.4% of North Carolinians are uninsured, similar to the 13.2% of COPD-related ED visits that were either paid for out of pocket or through an unknown/other mechanism. Further, 52.2% of COPD ED visits in 2020 were covered by Medicare, an insurance program primarily available to those age 65 years or older, indicating the disproportionate burden of COPD among the elderly. Authorized NC DETECT users can further investigate insurance status stratified by different demographics within the web application.
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