Department of Public Health and Clinical Medicine, Division of Medicine, Umeå University, Umeå, Sweden.
Division of Respiratory Medicine, Sunderby Hospital, 971 80 Luleå, Sweden.
Ther Adv Respir Dis. 2019 Jan-Dec;13:1753466619860058. doi: 10.1177/1753466619860058.
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.
All subjects with airway obstruction [forced expiratory volume in 1 second (FEV)/(forced) vital capacity ((F)VC) <0.70, = 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 FEV/(F)VC <0.70) and additionally, LLN-COPD (FEV/(F)VC <lower limit of normal). Mortality data was collected until December 2015.
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.
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.
合并症可能导致慢性阻塞性肺疾病（COPD）患者的死亡率增加，但基于人群的研究很少评估合并症对预后的性别差异。本研究旨在评估常见合并症（心血管疾病[CVD]、糖尿病[DM]和焦虑/抑郁[A/D]）对人群中存在和不存在气道阻塞的男性和女性死亡率的影响。
所有存在气道阻塞[1 秒用力呼气量（FEV）/用力肺活量（FVC）<0.70， = 993]的患者，与 2002-2004 年人群队列检查中年龄和性别匹配的参照者一起，通过对人群队列的检查被识别出来。肺功能分组：正常肺功能（NLF）和 COPD（支气管扩张剂后 FEV/FVC<0.70），以及另外的，LLN-COPD（FEV/FVC<正常下限）。死亡率数据收集至 2015 年 12 月。
在 COPD 中，CVD 和 DM 的患病率在男性中较高，而 A/D 的患病率在女性中较高。COPD 的累积死亡率明显高于 NLF，在 COPD 组中，男性的死亡率高于女性。在女性 COPD 患者中，CVD 和 A/D 但不是 DM 独立于年龄、体重指数、吸烟习惯和疾病严重程度增加死亡风险，而在男性中，DM 和 A/D 但不是 CVD 增加死亡风险。当应用 LLN 标准时，模式相似。
在 COPD 中，合并症对预后的影响存在性别依赖性差异。尽管 CVD 在男性中的患病率较高，但 CVD 对死亡率的影响在女性中更高，尽管 A/D 在女性中的患病率较高，但对死亡率的影响在两性中相似。
