• Andrea S Gershon, Jun Guan, J Charles Victor, Roger Goldstein, and Teresa To.
• Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto Ontario, Canada. andrea.gershon@ices.on.ca
• Am. J. Respir. Crit. Care Med.. 2013 Mar 15;187(6):596-601.

RationaleChronic obstructive pulmonary disease (COPD), a common manageable condition, is a leading cause of death. A better understanding of its impact on health-care systems would inform strategies to reduce its burden.ObjectivesTo quantify health services use in a large, North American COPD population.MethodsWe conducted a cohort study using health administrative data from Ontario, a province with a population of 13 million and universal health-care insurance. All individuals with physician-diagnosed COPD in 2008 were identified and followed for 3 years. Proportions of all hospital visits, emergency department visits, ambulatory care visits, long-term care residence places, and homecare made or used by people with COPD were determined and rates of each compared between people with and without COPD.Measurements And Main ResultsA total of 853,438 individuals with COPD (11.8% of the population aged 35 yr and older) were responsible for 24% of hospitalizations, 24% of emergency department visits, and 21% of ambulatory care visits; filled 35% of long-term care places; and used 30% of homecare services. After adjusting for several factors, people with COPD had rates of hospital, emergency department, and ambulatory care visits that were, respectively, 63%, 85%, and 48% higher than the rest of the population. Their rates of long-term care and homecare use were 56 and 59% higher, respectively.ConclusionsIndividuals with COPD use large and disproportionate amounts of health services. Strategies that target this group are needed to improve their health and minimize their need for health services.

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