Smoking, Respiratory Issues, Older Age Raise Hospital Costs, Chinese Study Finds

Older age, smoking, and having other respiratory symptoms and conditions increase the hospitalization costs of people with bronchiectasis, a large Chinese study says.

The findings also suggest that avoiding overuse of antibiotics may help lower hospital expenses in this patient population.

Titled “Clinical features related to hospital expenses for non-cystic fibrosis bronchiectasis in China,” the study was published in the Journal of International Medical Research.

Bronchiectasis is characterized by a permanent widening of the airways of the lung, which can be caused by congenital conditions such as cystic fibrosis (CF), or can be acquired. Non-CF bronchiectasis is associated with recurrent exacerbations, persistent airway inflammation, and chronic lung infections.

The causes and characteristics of bronchiectasis have been the focus of many previous studies. However, the economic burden associated with the irreversible and progressive condition is not well-known.

Now, researchers have conducted a study to investigate the economic burden of hospitalization due to bronchiectasis in China. The primary focus was determining what factors might influence hospitalization costs.

A total of 5,469 patients, with a mean age of 62.91 years, were included in the study. There were slightly more men (51.92%) than women. The patients were hospitalized 5,915 times in 18 hospitals across China, from 2010 to 2014.

Sputum analyses were performed during the hospitalizations on 2,907 patients, with 1,321 testing positive for disease-causing bacteria. Pseudomonas aeruginosa was the most common diagnosis (30.2%) in 399 cases, followed by Streptococcus pneumonia (6.66%) in 88 patients. Klebsiella pneumonia was found in 50 people (3.78%), while Haemophilus influenza was diagnosed in 11 patients (0.83%), and Staphylococcus aureus was found in 10 (0.75%).

The results from chest high-resolution computed tomography scans in 5,147 patients showed that more than one lung lobe — lung sections divided by thin walls of tissue — were infected in most cases. The lower lobe of the left lung was the most frequent site of infection (3,302 patients, 64.15%).

Antibiotics were administered in 5,681 cases (96.04%), with more than one antibiotic being given in 2,465 cases (43.39%). Cephalosporin was the most frequent choice.

Notably, although antibiotics were given to almost all patients, a sputum analysis had only been performed in nearly half of cases.

“Therefore, most antibiotics were prescribed empirically and lacked bacteriological evidence,” the team wrote.

The average length of hospital stay was 10.96 days. In the vast majority of cases (96.95%), the patients improved and were discharged from the hospital. However, 13 patients (0.24%) died.

The median overall cost of hospitalization was RMB 8,421.52 (approximately $1204). However, the average hospitalization cost was significantly different between hospitals and patients.

The study found that certain risk factors increased the hospitalization costs. Top among these were older age at admission — being older than 70 was associated with higher costs than being younger than 40 — and smoking, with greater costs associated with patients who smoked up to 15 packs of cigarettes per year versus non-smokers. Longer hospitalizations and death also led to increased costs.

Higher costs also were linked with having shortness of breath, cough, chronic obstructive pulmonary disease, respiratory failure, or cor pulmonale, a condition that causes the right side of the heart to fail.

Receiving combination antibiotic treatment also was a factor that increased hospital expenses.

“Paying greater attention to pathogen screening and avoiding overuse of antibiotics may lower the economic burden of non-CF bronchiectasis,” the researchers wrote.

The team noted that bronchiectasis can cause severe respiratory system damage in patients, which can lead to additional issues.

“Measures should be taken to strengthen early identification, early intervention, and standardized management in patients with bronchiectasis, to reduce the occurrence of complications and thereby reduce the economic burden of disease,” the researchers said.