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The impact of comorbidities on mortality among men and women with COPD: report from the OLIN COPD study
Sami Sawalha1,2, Linnea Hedman3,4, Helena Backman3
1Department of Public Health and Clinical Medicine, Division of Medicine, Umeå University, Umeå, Sweden.
Insights
Comorbidities impact mortality differently in men and women with chronic obstructive pulmonary disease (COPD). Cardiovascular disease (CVD) posed a higher risk for women, while diabetes mellitus (DM) and anxiety/depression (A/D) affected men more significantly.
Area of Science:
- Pulmonary Medicine
- Cardiology
- Endocrinology
- Psychiatry
Background:
- Comorbidities are linked to increased mortality in chronic obstructive pulmonary disease (COPD).
- Sex differences in the prognostic impact of comorbidities in COPD are understudied in population-based research.
- This study investigates the influence of cardiovascular disease (CVD), diabetes mellitus (DM), and anxiety/depression (A/D) on mortality in men and women with and without COPD.
Purpose of the Study:
- To determine the impact of common comorbidities on mortality in men and women with COPD.
- To explore sex-specific differences in how CVD, DM, and A/D affect COPD patient outcomes.
- To compare the prognostic significance of comorbidities in individuals with normal lung function versus those with COPD.
Main Methods:
- Population-based cohorts examined between 2002-2004 identified subjects with airway obstruction (FEV1/FVC <0.70) and age/sex-matched referents.
- Subjects were categorized into normal lung function (NLF) and COPD groups, with a subgroup defined by the lower limit of normal (LLN) criterion.
- Mortality data was collected up to December 2015 for all participants.
Main Results:
- In COPD patients, CVD and DM were more prevalent in men, while A/D was more common in women.
- COPD significantly increased mortality compared to NLF, with higher mortality in men than women across both groups.
- For women with COPD, CVD and A/D independently increased mortality risk; for men, DM and A/D did.
- The LLN criterion yielded similar patterns of comorbidity impact on mortality.
Conclusions:
- Significant sex-dependent differences exist in the prognostic impact of comorbidities on COPD mortality.
- Cardiovascular disease (CVD) had a greater impact on mortality in women with COPD, despite higher prevalence in men.
- Anxiety/depression (A/D) impacted mortality similarly in both sexes, while diabetes mellitus (DM) posed a greater risk for men.
Background:
Comorbidities probably contribute to the increased mortality observed among subjects with chronic obstructive pulmonary disease (COPD), but sex differences in the prognostic impact of comorbidities have rarely been evaluated in population-based studies. The aim of this study was to evaluate the impact of common comorbidities, cardiovascular disease (CVD), diabetes mellitus (DM), and anxiety/depression (A/D), on mortality among men and women with and without airway obstruction in a population-based study.
Methods:
All subjects with airway obstruction [forced expiratory volume in 1 second (FEV1)/(forced) vital capacity ((F)VC) <0.70, n = 993] were, together with age- and sex-matched referents, identified after examinations of population-based cohorts in 2002-2004. Spirometric groups: normal lung function (NLF) and COPD (post-bronchodilator FEV1/(F)VC <0.70) and additionally, LLN-COPD (FEV1/(F)VC
Results:
In COPD, the prevalence of CVD and DM was higher in men, whereas the prevalence of A/D was higher in women. The cumulative mortality was significantly higher in COPD than NLF, and higher in men than women in both groups. Among women with COPD, CVD and A/D but not DM increased the risk of death independent of age, body mass index, smoking habits, and disease severity, whereas among men DM and A/D but not CVD increased the risk for death. When the LLN criterion was applied, the pattern was similar.
Conclusion:
There were sex-dependent differences regarding the impact of comorbidities on prognosis in COPD. Even though the prevalence of CVD was higher in men, the impact of CVD on mortality was higher in women, and despite higher prevalence of A/D in women, the impact on mortality was similar in both sexes. The reviews of this paper are available via the supplemental material section.
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