BODE Index, Comorbidities Valuable for Predicting COPD Healthcare Resource Utilization

March 21, 2020

Chronic obstructive pulmonary disease (COPD) may incur huge medical expenses, resulting in a heavy socioeconomic burden. A recent study sought to predict the level of healthcare utilization resources.

The BODE (body mass index, airflow obstruction, dyspnea, and exercise capacity) index was positively correlated with the number of hospitalizations, hospitalization days, hospitalization expenses, and total medical expenses, in a recent study published by the International Journal of Chronic Obstructive Pulmonary Disease.

The study involved an assessment of the clinical outcomes of chronic obstructive pulmonary disease (COPD) with complete BODE index data from January 2015 to December 2016. The researchers also analyzed the correlation between BODE index, Charlson comorbidity index (CCI), and medical resources based on patients’ medical records from January 2015 to August 2017.

The BODE index includes 4 independent predictors: body mass index (BMI), forced expiratory volume in 1 second (FEV1), the modified Medical Research Council (mMRC) dyspnea scale, and exercise capacity as measured by the 6-minute walking distance (6MWD) test. The authors said the BODE index is a better predictor of disease severity, number of acute exacerbations, and mortality than the FEV1. Saint George’s Respiratory Questionnaire (SGRQ) is also an instrument that provides information on quality of life.

In total, 396 patients with COPD met the inclusion criteria for the study. The results demonstrated that healthcare resource utilization was positively correlated with the BODE index during the 32 months of retrospective clinical outcomes. Additionally, there was a significant association between the BODE index and the CCI of COPD patients (P < .001). In-hospitalization expenses were positively correlated with CCI (P < .001).

In addition, BODE quartiles were positively correlated with number of hospitalizations (P < .001), hospitalization days (P <.001), hospitalization expenses (P = .005), and total medical expenses (P = .024). The highest quartile indicates the most severe level of COPD.

CCI is correlated with medical expenses because of the many comorbidities in COPD, including myocardial infarction, chronic heart failure, peripheral vascular disease, cerebrovascular disease, and more. As a chronic inflammatory pulmonary disease, inflammatory mediators spill into the blood stream and injure other organs, the authors noted.

The researchers concluded that with the same CCI, higher quartile translate into higher hospitalization expenses. Therefore, the BODE index and CCI together can accurately predict the medical expenses of COPD, they said.


Li CL, Lin MH, Chen PS, et al. Using the BODE index and comorbidities to predict health utilization resources in chronic obstructive pulmonary disease [published online February 5, 2020]. Int J Chron Obstruct Pulmon. doi: 10.2147/COPD.S234363.