Dataset Information

Effect of multiple comorbidities on mortality in chronic obstructive pulmonary disease among Korean population: a nationwide cohort study.

ABSTRACT:

Background

The effects of comorbidities on chronic obstructive pulmonary disease (COPD) have been usually studied individually in the past. In this study, we aimed to investigate the comorbidities associated with mortality, the effect of multimorbidity on mortality and other factors associated with mortality among Korean COPD population.

Methods

The Korean National Health Insurance Service-National Sample Cohort version 2.0, collected between 2002 and 2015, was used. Among COPD patients [entire cohort (EC), N?=?12,779], 44% of the participants underwent additional health examination, and they were analysed separately [health-screening cohort (HSC), N?=?5624]. Fifteen comorbidities previously reported as risk factors for mortality were studied using Cox proportional hazards regression models.

Results

Total mortality rates were 38.6 per 1000 person-years (95% CI 37.32-40.01) and 27.4 per 1000 person-years (95% CI 25.68-29.22) in EC and HSC, respectively. The most common causes of death were disease progression, lung cancer, and pneumonia. Only some of the comorbidities had a direct impact on mortality. Multimorbidity, assessed by the number of comorbid diseases, was an independent risk factor of all-cause mortality in both cohorts and was a risk factor of respiratory mortality only in HSC. The Kaplan-Meier analysis showed significant differences in survival trajectories according to the number of comorbidities in all-cause mortality but not in respiratory mortality. Low BMI, old age and male sex were independent risk factors for both mortalities in both cohorts.

Conclusions

The number of comorbidities might be an independent risk factor of COPD mortality. Multimorbidity contributes to all-cause mortality in COPD, but the effect of multimorbidity is less evident on respiratory mortality.

SUBMITTER: Kim Y

PROVIDER: S-EPMC7879613 | biostudies-literature | 2021 Feb

REPOSITORIES: biostudies-literature

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Publications

Effect of multiple comorbidities on mortality in chronic obstructive pulmonary disease among Korean population: a nationwide cohort study.

Kim Youngmee Y Kim Ye-Jee YJ Cho Won-Kyung WK

BMC pulmonary medicine 20210211 1

<h4>Background</h4>The effects of comorbidities on chronic obstructive pulmonary disease (COPD) have been usually studied individually in the past. In this study, we aimed to investigate the comorbidities associated with mortality, the effect of multimorbidity on mortality and other factors associated with mortality among Korean COPD population.<h4>Methods</h4>The Korean National Health Insurance Service-National Sample Cohort version 2.0, collected between 2002 and 2015, was used. Among COPD pa ...[more]

PMID: 33573635

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Project description:Multi-morbidity is common in patients with chronic obstructive pulmonary disease and low levels of physical activity are hypothesized to be an important risk factor. The current study aimed to assess the longitudinal association between physical activity and risk of seven categories of comorbidity in chronic obstructive pulmonary disease patients. The study included 409 patients from primary care practice in the Netherlands and Switzerland. We assessed physical activity using the Longitudinal Ageing Study Amsterdam Physical Activity Questionnaire at baseline and followed patients for up to 5 years. During follow-up, patients reported their comorbidities (cardiovascular, neurological, endocrine, musculoskeletal, malignant, and infectious diseases) and completed the Hospital Anxiety and Depression Scale questionnaire for mental health assessment. We implemented multinomial logistic regression (an approximation to discrete time survival model using death as a competing risk) for our analysis. Study results did not suggest a statistically significant association of baseline physical activity with the development of seven categories of comorbidity. However, when we focused on depression and anxiety symptoms, we found that higher levels of physical activity at baseline were associated with a lower risk for depression (adjusted hazard ratio, 0.85; 0.75-0.95; p?=?0.005) and anxiety (adjusted hazard ratio, 0.89; 0.79-1.00; p?=?0.045). In chronic obstructive pulmonary disease patients, those with high physical activity are less likely to develop depression or anxiety symptoms over time. Increasing physical activity in chronic obstructive pulmonary disease patients may be an approach for testing to lower the burden from incident depression and anxiety.STAY ACTIVE TO AVOID DEPRESSION AND ANXIETY: Patients with chronic lung disease who stay physically active could reduce their chances of depression and anxiety. Milo Puhan at the University of Zurich, Switzerland, and co-workers assessed the association between physical activity and the risk of developing various co-existing diseases in 409 patients with chronic obstructive pulmonary disease (COPD). Co-morbidities such as cardiovascular diseases, diabetes and depression are prevalent in patients with COPD, but the reasons why are not clear. Puhan's team assessed patients' activity levels using an existing questionnaire, and administered another questionnaire to assess mental health. They followed the cohort for 5 years. Results indicated weak associations between physical activity levels and most physical illnesses, but there were significant links between higher levels of physical activity and a reduced risk of depression and anxiety. The results could inform novel COPD treatment programs.

Project description:Regular physical activity is recommended for all people with chronic obstructive pulmonary disease (COPD), but the dose of physical activity required to gain mortality benefit in this population is not yet known. This aim of this study was to examine the associations of total and type-specific physical activity with mortality risk in people with COPD.People with COPD aged ?40 years were identified from the 1997 Health Survey for England and the 1998 and 2003 Scottish Health Survey cohorts. Self-reported total physical activity, moderate-vigorous intensity physical activity (MVPA), walking, domestic physical activity, and sport/exercise were assessed at baseline. Cox proportional hazards models were used to examine the associations between physical activity and mortality risk.Two thousand three hundred ninety-eight participants with COPD were included in the analysis and followed up for a mean 8.5 (SD 3.9) years. For both total physical activity and MVPA, we observed dose-response associations with all-cause and cardiovascular disease (CVD) mortality risk, and with respiratory mortality risk to a lesser extent. Compared to those who reported no physical activity, participants who met the physical activity guidelines demonstrated the greatest reductions in all-cause (HR 0.56, 95% CI 0.45-0.69), CVD (HR 0.48, 95% CI 0.32-0.71) and respiratory mortality risk (HR 0.40, 95% CI 0.24-0.67). Participants who reported a level of physical activity of at least half the dosage recommended by the guidelines also had a reduced risk of all-cause (HR 0.75, 95% CI 0.56-1.00) and CVD mortality (HR 0.48, 95% CI 0.26-0.88). Dose-response associations with mortality risk were demonstrated for walking and sport/exercise, but not domestic physical activity.We found a dose-response association between physical activity and all-cause and CVD mortality risk in people with COPD, with protective effects appearing at levels considerably lower than the general physical activity recommendations. People with COPD may benefit from engagement in low levels of physical activity, particularly walking and structured exercise.

Dataset Information

Effect of multiple comorbidities on mortality in chronic obstructive pulmonary disease among Korean population: a nationwide cohort study.

Background

Methods

Results

Conclusions

Publications

Effect of multiple comorbidities on mortality in chronic obstructive pulmonary disease among Korean population: a nationwide cohort study.

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