TABLE 2 ] .
Patterns of Ventilation Use According to Patient Characteristics, 2001 to 2011
| Outcome: Ventilation Type/Patient Population | |||||
| Variable | Any Ventilationa/All Patientsb | NIV Initialc/All Patientsb | IMV Initiald/All Patientsb | NIV Proportione/Patients Who Are Ventilatedf | NIV Failureg/Patients on NIVh |
| Year (annual change) | 1.06 (1.05-1.07) | 1.14 (1.12-1.17) | 0.95 (0.94-0.96) | 1.19 (1.17-1.21) | 0.96 (0.93-0.98) |
| Sex | |||||
| Male | Ref | Ref | Ref | Ref | Ref |
| Female | 0.99 (0.98-1.01) | 1.01 (1.00-1.03) | 0.96 (0.95-0.98) | 1.05 (1.02-1.08) | 0.98 (0.94-1.02) |
| Age | |||||
| < 65 y | Ref | Ref | Ref | Ref | Ref |
| 65-74 y | 0.93 (0.89-0.96) | 0.97 (0.92-1.01) | 0.92 (0.88-0.96) | 1.06 (0.99-1.14) | 0.87 (0.76-0.98) |
| 75-84 y | 0.66 (0.64-0.69) | 0.76 (0.72-0.8) | 0.67 (0.63-0.7) | 1.12 (1.04-1.21) | 0.75 (0.64-0.85) |
| ≥ 85 y | 0.43 (0.41-0.46) | 0.56 (0.52-0.6) | 0.45 (0.41-0.48) | 1.22 (1.07-1.38) | 0.50 (0.37-0.62) |
| Age-by-year interaction | |||||
| < 65 y | Ref | Ref | Ref | Ref | Ref |
| 65-74 y | 1.00 (0.99-1.01) | 1.00 (1.00-1.01) | 0.99 (0.98-1.00) | 1.01 (1.00-1.02) | 0.99 (0.97-1.00) |
| 75-84 y | 1.01 (1.00-1.01) | 1.01 (1.00-1.02) | 0.98 (0.98-0.99) | 1.03 (1.02-1.04) | 0.97 (0.95-0.99) |
| ≥ 85 y | 1.02 (1.01-1.03) | 1.02 (1.01-1.03) | 0.99 (0.97-1.00) | 1.04 (1.02-1.06) | 0.98 (0.94-1.01) |
| Race | |||||
| White | Ref | Ref | Ref | Ref | … |
| Hispanic | 0.89 (0.81-0.97) | 0.90 (0.85-0.94) | 0.93 (0.82-1.05) | 0.90 (0.82-0.98) | 0.98 (0.83-1.12) |
| Black | 1.11 (1.05-1.17) | 0.99 (0.96-1.02) | 1.20 (1.12-1.29) | 0.86 (0.82-0.90) | 1.02 (0.94-1.10) |
| Other | 1.13 (1.07-1.20) | 1.00 (0.97-1.04) | 1.15 (1.06-1.24) | 0.91 (0.86-0.96) | 1.01 (0.92-1.10) |
| Race-by-year interaction | |||||
| White | Ref | … | Ref | … | … |
| Hispanic | 1.00 (0.99-1.02) | … | 1.01 (0.99-1.03) | … | … |
| Black | 0.99 (0.98-1.00) | … | 0.99 (0.98-1.00) | … | … |
| Other | 0.99 (0.98-1.00) | … | 0.99 (0.98-1.01) | … | … |
| Comorbidity score | |||||
| Low: ≤ 1 | Ref | Ref | Ref | Ref | Ref |
| Medium: 2-3 | 2.02 (1.95-2.09) | 1.68 (1.60-1.76) | 2.04 (1.99-2.09) | 0.88 (0.81-0.94) | 1.39 (1.19-1.59) |
| High: ≥ 4 | 4.04 (3.89-4.19) | 2.66 (2.53-2.79) | 4.01 (3.91-4.11) | 0.73 (0.68-0.79) | 2.11 (1.81-2.41) |
| Comorbid score-by-year interaction | |||||
| Low: ≤ 1 | Ref | Ref | … | Ref | Ref |
| Medium: 2-3 | 0.98 (0.98-0.99) | 0.99 (0.98-1.00) | … | 0.98 (0.97-0.99) | 1.01 (0.99-1.04) |
| High: ≥ 4 | 0.97 (0.96-0.97) | 0.98 (0.97-0.99) | … | 0.97 (0.96-0.98) | 1.03 (1.01-1.05) |
| Pneumonia | |||||
| No pneumonia | Ref | Ref | Ref | Ref | Ref |
| Pneumonia | 5.62 (5.43-5.81) | 2.75 (2.62-2.88) | 5.88 (5.64-6.13) | 0.55 (0.54-0.57) | 2.6 (2.47-2.72) |
| Pneumonia-by-year interaction | |||||
| No pneumonia | Ref | Ref | Ref | … | … |
| Pneumonia | 0.88 (0.87-0.88) | 0.92 (0.91-0.93) | 0.90 (0.90-0.91) | … | … |
| COPD prior admit | |||||
| None | Ref | Ref | Ref | Ref | Ref |
| 1 | 1.25 (1.21-1.30) | 1.47 (1.44-1.50) | 1.04 (0.99-1.10) | 1.39 (1.28-1.49) | 0.85 (0.80-0.90) |
| 2 | 1.39 (1.32-1.47) | 1.79 (1.74-1.84) | 0.96 (0.89-1.04) | 1.71 (1.52-1.90) | 0.86 (0.79-0.93) |
| ≥ 3 | 1.66 (1.58-1.75) | 2.21 (2.15-2.27) | 1.16 (1.07-1.24) | 1.70 (1.52-1.89) | 0.72 (0.66-0.78) |
| COPD prior admit-by-year interaction | |||||
| None | Ref | … | Ref | … | … |
| 1 | 1.01 (1.01-1.02) | … | 1.00 (1.00-1.01) | … | … |
| 2 | 1.02 (1.01-1.03) | … | 1.02 (1.01-1.03) | … | … |
| ≥ 3 | 1.02 (1.01-1.03) | … | 1.00 (0.99-1.01) | … | … |
Data are presented as OR (95% CI). Ventilation type refers to the ventilation therapy administered during admission. Patient population refers to the population eligible for each type of ventilation. All models were adjusted for year, sex, age group, race, combined comorbidity score, concomitant pneumonia, COPD prior admission, and hospital characteristics (ie, number of beds, teaching status, urban/rural geographical area). Initial models evaluated interaction terms for year with sex, age group, race, comorbidity score, concomitant pneumonia, and prior COPD admissions. Nonsignificant interaction terms (P > .05) were dropped from final models reported here. For NIV proportion and NIV failure, we also adjusted for annual hospital ventilation rate. Main effect OR estimates apply to baseline year 2001. Multiply by the year interaction effect for each subsequent year. For example, the OR 4.04 (3.89-4.19) indicates that in 2001, patients with a high comorbidity burden were 4.04 times more likely to be ventilated than were patients with a low comorbidity burden. The interaction effect with year, OR 0.97 (0.96-0.97), indicates that the odds of ventilation for patients with a high comorbidity burden decreased by a factor of 0.97 times per year, so that 10 years later, by 2011, they were 4.04 × 0.9710 = 2.98 times more likely to be ventilated than were those with a low comorbidity burden. IMV = invasive mechanical ventilation; NIV = noninvasive ventilation; Ref = reference.
Any NIV or IMV during hospitalization.
All admissions included in the analysis.
NIV was the ventilation type that was used first.
IMV was the ventilation type that was used first.
NIV was used first as the ventilatory therapy.
Admissions among all patients who were ventilated.
Transition to IMV after a trial of NIV.
Admissions among all patients ventilated with NIV initially.