Power Outage: An Ignored Risk Factor for COPD Exacerbations

• Published in: Chest Vol. 158; no. 6; pp. 2346 - 2357
• Main Authors: Zhang, Wangjian, Sheridan, Scott C, Birkhead, Guthrie S, Croft, Daniel P, Brotzge, Jerald A, Justino, John G, Stuart, Neil A, Du, Zhicheng, Romeiko, Xiaobo X, Ye, Bo, Dong, Guanghui, Hao, Yuantao, Lin, Shao
• Format: Journal Article
• Language: English
• Published: United States American College of Chest Physicians 01.12.2020
• Subjects: Acute Disease; Bronchitis - economics; Bronchitis - epidemiology; Bronchitis - therapy; Comorbidity; COPD: Original Research; Disease Progression; Electric Power Supplies - standards; Electric Power Supplies - statistics & numerical data; Female; Health Status Indicators; Hospital Costs - trends; Hospitalization - economics; Hospitalization - statistics & numerical data; Humans; Male; Middle Aged; Pulmonary Disease, Chronic Obstructive - economics; Pulmonary Disease, Chronic Obstructive - epidemiology; Pulmonary Disease, Chronic Obstructive - physiopathology; Pulmonary Disease, Chronic Obstructive - therapy; Risk Assessment; Risk Factors; Severity of Illness Index; Symptom Flare Up; United States - epidemiology; United States; medical indicator; sociodemographic; COPD; power outage
• ISSN: 1931-3543; 0012-3692; 1931-3543
• DOI: 10.1016/j.chest.2020.05.555

COPD is the third leading cause of death in the United States, with 16 million Americans currently experiencing difficulty with breathing. Power outages could be life-threatening for those relying on electricity. However, significant gaps remain in understanding the potential impact of power outages on COPD exacerbations. The goal of this study was to determine how power outages affect COPD exacerbations. Using distributed lag nonlinear models controlling for time-varying confounders, the hospitalization rate during a power outage was compared vs non-outage periods to determine the rate ratio (RR) for COPD and its subtypes at each of 0 to 6 lag days in New York State from 2001 to 2013. Stratified analyses were conducted according to sociodemographic characteristics, season, and clinical severity; changes were investigated in numerous critical medical indicators, including length of stay, hospital cost, the number of comorbidities, and therapeutic procedures between the two periods. The RR of COPD hospitalization following power outages ranged from 1.03 to 1.39 across lag days. The risk was strongest at lag and lag days and lasted significantly for 7 days. Associations were stronger for the subgroup with acute bronchitis (RR, 1.08-1.69) than for cases of acute exacerbation (RR, 1.03-1.40). Compared with non-outage periods, the outage period was observed to be $4.67 thousand greater in hospital cost and 1.38 greater in the number of comorbidities per case. The average cost (or number of comorbidities) was elevated in all groups stratified according to cost (or number of comorbidities). In contrast, changes in the average length of stay (-0.43 day) and the average number of therapeutic procedures (-0.09) were subtle. Power outages were associated with a significantly elevated rate of COPD hospitalization, as well as greater costs and number of comorbidities. The average cost and number of comorbidities were elevated in all clinical severity groups.