Resource Use During the Last Six Months of Life Among COPD Patients: A Population-Level Study: a population level study

Context: Chronic obstructive pulmonary disease (COPD) patients often have several comorbidities, such as cardiovascular diseases (CVDs) or lung cancer (LC), which might influence resource use in the final months of life. However, no previous studies documented end-of-life resource use in COPD patients at a population level, thereby differentiating whether COPD patients die of their COPD, CVD, or LC. Objectives: The objectives of the study were to describe end-of-life resource use in people diagnosed with COPD and compare this resource use between those dying of COPD, CVD, and LC. Methods: We performed a full-population retrospective analysis of all Belgian decedents. Those who died of COPD were selected based on the primary cause of death. Those who died with COPD but with CVD or LC as a primary cause of death were identified based on a validated algorithm expanded with COPD as intermediate or associated. Results: Resource use among 13,086 patients dying of or with COPD was studied. Those who died of COPD received less opioids, sedatives, and morphine; used less palliative care services; and received more invasive and noninvasive ventilation as compared to the other two groups. Those who died of LC had more specialist contacts, hospital admissions, and medical imaging as compared to those who died of COPD or CVD. Those who died of CVD used less palliative care services when compared to those who died of LC and had a comparable use of hospital, intensive care unit, home care, opioids, sedatives, and morphine when compared to those who died of COPD. Conclusion: The presence of lung cancer and CVDs influences resource use in COPD patients at life's end. We recommend that future research on end-of-life care in COPD patients systematically accounts for specific comorbidities.