Community determinants of COPD exacerbations in elderly patients in Lodz province, Poland: a retrospective observational Big Data cohort study

OBJECTIVES: To evaluate the prevalence and identify demographic, economic and environmental local community determinants of chronic obstructive pulmonary disease (COPD) exacerbations in elderly in primary care using Big Data approach. DESIGN: Retrospective observational case–control study based on Big Data from the National Health Found, Tax Office and National Statistics Center databases in 2016. SETTING: Primary care clinics in the Lodz province in Poland. PARTICIPANTS: 472 314 patients aged 65 and older in primary care, including 17 240 patients with COPD and 1784 with exacerbations (including deaths). OUTCOME MEASURES: Exacerbations with demographic, economic and environmental local community determinants were retrieved. Conditional logistic regression for matched pairs was used to evaluate the local community determinants of COPD exacerbations among patients with COPD. RESULTS: The overall prevalence of COPD in the population of elderly patients registered in primary healthcare clinic clinics in Lodz province in 2016 was 3.65%, 95% CI (3.60% to 3.70%) and the prevalence of exacerbations was 10.35%, 95% CI (9.89% to 10.80%). The high number of consultations in primary care clinics was associated with higher risk of COPD exacerbations (p=0.0687). High-income patients were less likely to have exacerbations than low-income patients (high vs low OR 0.601, 95% CI (0.385 to 0.939)). The specialisation of the primary care physician did not have an effect on exacerbations (OR 1.076, 95% CI (0.920 to 1.257)). Neither the forest cover per gmina (high vs low OR 0.897, 95% CI (0.605 to 1.331); medium vs low OR 0.925, 95% CI (0.648 to 1.322)), nor location of gmina (urban vs urban–rural OR 1.044; 95% CI (0.673 to 1.620)), (rural vs urban–rural OR 0.897, 95% CI (0.630 to 1.277)) appears to influence COPD exacerbations. CONCLUSIONS: Big Data statistical analysis facilitated the evaluation of the prevalence and determinants of COPD exacerbation in the elderly residents of Lodz province, Poland. Modification of identified local community determinants may potentially decrease the number of exacerbations in elderly patients with COPD.