Comorbidity in lung cancer patients and its association with hospital readmission and fatality in China

Dawei Zhu,Zhishui Chen,Xuefeng Shi,Yong Ma,Ping He,Ruoxi Ding

doi:10.1186/s12885-021-08272-y

Abstract

BackgroundComorbidity has been established as one of the important predictors of poor prognosis in lung cancer. In this study, we analyzed the prevalence of main comorbidities and its association with hospital readmission and fatality for lung cancer patients in China.MethodsThe analyses are based on China Urban Employees’ Basic Medical insurance (UEBMI) and Urban Residents’ Basic Medical Insurance (URBMI) claims database and Hospital Information System (HIS) Database in the Beijing University Cancer Hospital in 2013–2016. We use Elixhauser Comorbidity Index to identify main types of comorbidities.ResultsAmong 10,175 lung cancer patients, 32.2% had at least one comorbid condition, and the proportion of patients with one, two, and three or more comorbidities was 21.7, 8.3 and 2.2%, respectively. The most prevalent comorbidities identified were other malignancy (7.5%), hypertension (5.4%), pulmonary disease (3.7%), diabetes mellitus (2.5%), cardiovascular disease (2.4%) and liver disease (2.3%). The predicted probability of having comorbidity and the predicted number of comorbidities was higher for middle elderly age groups, and then decreased among patients older than 85 years. Comorbidity was positively associated with increased risk of 31-days readmission and in-hospital death.ConclusionOur study is the first to provide an overview of comorbidity among lung cancer patients in China, underlines the necessity of incorporating comorbidity in the design of screening, treatment and management of lung cancer patients in China.

Highlights

Comorbidity has been established as one of the important predictors of poor prognosis in lung cancer
The diagnosis of lung cancer is associated with advanced age and smoking, both of which are related to the occurrence of concomitant chronic diseases [9, 10]
Using claims data from China Urban Employee’s Basic Medical Insurance (UEBMI) and China Urban Residents’ Basic Medical Insurance (URBMI), this study aims to analyze the prevalence of main comorbidities and its association with hospital readmission and fatality for lung cancer patients in urban population, which accounted for more than 55% of new cases and lung cancer deaths in China [5]

Summary

Introduction

Comorbidity has been established as one of the important predictors of poor prognosis in lung cancer. Comorbidity has been established as one of the key predictors of poor prognosis in different cancers [11] It potentially affects lung cancer survival by influencing the choice of antineoplastic treatment [12] and by camouflaging the cancer symptoms and causing diagnosis delay [13]. Despite the increasing recognition of the impact of comorbidity on lung cancer treatment and prognosis from western studies, little research has investigated comorbidities in lung cancer patients in China, leaving the prevalence and main types, as well as the impact of concomitant conditions unknown, not to mention the urgent need in such a country with rapid population aging, air pollution and a large smoking population [5]

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Discussion

Conclusion