Chest
Volume 142, Issue 2, August 2012, Pages 432-439
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Original Research
Bronchiectasis
Trends in Bronchiectasis Among Medicare Beneficiaries in the United States, 2000 to 2007

https://doi.org/10.1378/chest.11-2209Get rights and content

Background

Bronchiectasis is a potentially serious condition characterized by permanent and abnormal widening of the airways, the prevalence of which is not well described. We sought to describe the trends, associated conditions, and risk factors for bronchiectasis among adults aged ≥ 65 years.

Methods

A 5% sample of the Medicare outpatient claims database was analyzed for bronchiectasis trends among beneficiaries aged ≥ 65 years from 2000 to 2007. Bronchiectasis was identified using International Classification of Diseases, Ninth Revision, Clinical Modification claim diagnosis codes for acquired bronchiectasis. Period prevalence was used to describe sex- and race/ethnicity-specific rates, and annual prevalence was used to describe trends and age-specific rates. We estimated trends using Poisson regression and odds of bronchiectasis using multivariate logistic regression.

Results

From 2000 to 2007, 22,296 people had at least one claim for bronchiectasis. The 8-year period prevalence of bronchiectasis was 1,106 cases per 100,000 people. Bronchiectasis increased by 8.7% per year. We identified an interaction between the number of thoracic CT scans and race/ethnicity; period prevalence varied by a greater degree by number of thoracic CT scans among Asians compared with whites or blacks. Among people with one CT scan, Asians had a 2.5- and 3.9-fold higher period prevalence compared with whites and blacks.

Conclusions

Bronchiectasis prevalence increased significantly from 2000 to 2007 in the Medicare outpatient setting and varied by age, sex, and race/ethnicity. This increase could be due to a true increase in the condition or an increased recognition of previously undiagnosed cases.

Section snippets

Databases and Populations

We analyzed a 5% sample of the carrier and the denominator standard analytic files (SAFs) obtained from CMS. The 5% sample was randomly selected from all carrier claims by CMS. The carrier SAFs contain claims-level information from noninstitutional outpatient health-care providers. The denominator SAFs include annual demographic and enrollment information for each Medicare beneficiary (e-Appendix 1).

Data Analysis and Ethical Review

We analyzed claims from 2000 to 2007 to estimate prevalence and trends of bronchiectasis and to

Results

The study population included > 2 million unique individuals enrolled in Medicare Part B for at least 1 month from 2000 through 2007. Medicare beneficiaries from all 50 states and the District of Columbia were represented. The demographic distribution was representative of the entire US population aged ≥ 65 years.

We identified 117,112 claims of bronchiectasis from 2000 to 2007 from 22,296 people for an average of approximately five claims per person during this period. These individuals

Discussion

We analyzed CMS databases to describe nationally representative patterns of prevalence and trends of bronchiectasis in the older adult US outpatient population. Based on the number of cases identified in this analysis and extrapolating to the 2007 US population aged ≥ 65 years, we estimate that > 190,000 unique cases of bronchiectasis were assessed by a physician in the older adult US population in that year. Bronchiectasis prevalence increased significantly from 2000 to 2007 among both men and

Conclusions

We observed an increasing prevalence of bronchiectasis in the outpatient Medicare population and an overall higher prevalence for women and Asians. The increased prevalence among Asians was observed at all levels of thoracic CT scan use and was greatest with four to six scans across the 8-year period. This increasing prevalence may be due to increased recognition of previously undiagnosed cases or a true increase in incidence, highlighting the need for increased awareness of this condition.

Acknowledgments

Author contributions: Ms Seitz and Dr Prevots had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Ms Seitz: contributed to the study concept and design; data acquisition and management; statistical and epidemiologic analyses; interpretation of results; drafting of the manuscript; and manuscript preparation, revision, final edit, and approval of the final version.

Dr Olivier: contributed to the study concept

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    Funding/Support: This research was supported by the Intramural Research Program of the National Institutes of Health, National Institute of Allergy and Infectious Diseases.

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