ArticleInternational journal of chronic obstructive pulmonary disease2026
Continuity of Care and Risks of Hospitalization and Mortality in COPD: A Nationwide Cohort Study.
Article in International journal of chronic obstructive pulmonary disease, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Purpose: Chronic obstructive pulmonary disease (COPD) is characterized by unpredictable patterns of exacerbations, making continuity of care (CoC) a critical component in disease management. CoC influences COPD exacerbation-related hospitalization and mortality. Therefore, we assessed the impact of CoC levels on subsequent hospital admissions and all-cause mortality among individuals with COPD. Patients and Methods: This retrospective nationwide cohort study utilized National Health Insurance Service-Senior cohort data (2002-2019) and included 29,316 patients newly diagnosed with COPD. The primary exposure was longitudinal CoC level categorized as low (<0.7) or high (≥0.7). Alternative continuity indices (usual care provider, sequential continuity, and modified continuity indices) were also evaluated. Outcomes were COPD exacerbation-related hospitalization and all-cause mortality within 1 year of diagnosis. Cox proportional hazards models estimated hazard ratios (HRs), Kaplan-Meier curves, and cumulative incidence rates were used to assess outcomes, and the Log rank test was used for between-group comparisons. Results: Low CoC level were associated with an increased risk of 3-year COPD exacerbation-related hospitalization (HR 1.63, 95% CI 1.45-1.83) and all-cause mortality (HR 1.25, 95% CI 1.11-1.40) compared with high CoC level. Intermediate (0.4-0.7) and low (<0.4) CoC level showed progressively increased hospitalizations (HR 1.61, 95% CI 1.40-1.86 vs HR 1.65, 95% CI 1.38-1.97), and mortality (HR 1.24, 95% CI 1.07-1.43 vs HR 1.26, 95% CI 1.05-1.51), respectively. These findings remained consistent across alternative continuity indices. Low CoC level were associated with an increased risk of emergency (HR 1.48, 95% CI 1.19-1.83) and general hospital admissions (HR 1.70, 95% CI 1.47-1.95). Conclusion: Lower CoC scores level consistently associated with higher risks of COPD hospitalization and all-cause mortality across multiple continuity indices. Subgroup and sensitivity analyses indicated that fragmented outpatient care increased adverse outcomes. Strengthening longitudinal patient-provider relationships may reduce preventable hospitalizations and premature deaths in patients with COPD.
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