{
  "abstract": "Background Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are a leading cause of hospital admissions, early mortality and readmissions. Italian data are outdated and fragmented, and the impact of COVID-19 on AECOPD outcomes remains unclear.Methods We conducted a nationwide descriptive analysis of aggregated administrative indicators derived from two institutional sources (SDO (Schede di Dimissione Ospedaliera) and AGENAS (Agenzia Nazionale per i Servizi Sanitari Regionali)), reporting national and regional trends in hospitalisations, 30-day postdischarge mortality and 30-day readmissions for AECOPD between 2015 and 2023. Data were compared across pre-COVID (2015–2019), COVID (2020–2021) and post-COVID (2022–2023) periods and stratified by region and health district. Analyses were descriptive and based on aggregated, standardised administrative indicators, with temporal and regional comparisons across pre-COVID, COVID and post-COVID periods.Results AECOPD hospitalisations declined by more than 45% during 2020–2021, with only partial recovery by 2023 (−24% vs 2019). Thirty-day postdischarge mortality rose sharply during the pandemic, peaking at 13.6% in 2021 (+47% vs 2019), before returning near baseline in 2023, though excess mortality persisted in several southern regions. Thirty-day readmission rates remained stable at 12%–14% across the study period. Importantly, SDO records captured only one quarter of cases identified by AGENAS, systematically underestimating the true hospitalisation burden.Conclusions COVID-19 profoundly disrupted AECOPD care in Italy, exposing entrenched regional inequities and critical limitations in administrative data. These findings call for modernisation of coding systems, strengthening of community-based respiratory care and implementation of structured discharge and follow-up pathways to ensure equity and resilience in COPD management.",
  "authors": [
    {
      "affiliations": [
        "Department of Methods and Models for Economics, Territory and Finance, Sapienza University of Rome, Rome, Italy"
      ],
      "name": "Emanuela Resta"
    },
    {
      "affiliations": [
        "institute of Respiratory Disease Bari, Department of Basic Medical Sciences, Neuroscience and Sense Organs IT 70121, University of Bari Aldo Moro, Bari, Apulia, Italy"
      ],
      "name": "Vitaliano Nicola Quaranta"
    },
    {
      "affiliations": [
        "institute of Respiratory Disease Bari, Department of Basic Medical Sciences, Neuroscience and Sense Organs IT 70121, University of Bari Aldo Moro, Bari, Apulia, Italy"
      ],
      "name": "Silvano Dragonieri"
    },
    {
      "affiliations": [
        "Department of Computer Science, APJ Abdul Kalam University, Kerala, India"
      ],
      "name": "Preethymol Peter"
    },
    {
      "affiliations": [
        "institute of Respiratory Disease Bari, Department of Basic Medical Sciences, Neuroscience and Sense Organs IT 70121, University of Bari Aldo Moro, Bari, Apulia, Italy"
      ],
      "name": "Andrea Portacci"
    },
    {
      "affiliations": [
        "Department of Interdisciplinary Medicine, University of Bari Aldo Moro, Bari, Italy"
      ],
      "name": "Silvio Tafuri"
    },
    {
      "affiliations": [
        "Respiratory Medicine, Libera Universita Mediterranea, Casamassima, Apulia, Italy",
        "Ecclesiastical Entity General Regional Hospital Francesco Miulli, Acquaviva delle Fonti, Apulia, Italy"
      ],
      "name": "Paola Pierucci"
    },
    {
      "affiliations": [
        "Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Apulia, Italy"
      ],
      "name": "Giovanna Elisiana Carpagnano"
    }
  ],
  "title": "Nationwide trends in AECOPD care in Italy before, during and after COVID-19: discrepancies between data sources and across regions",
  "uid": "47cc083d-0932-54b0-8fd9-c1e47e183633"
}