Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China.
Department of Public Health, National Cheng Kung University, Tainan, Taiwan.
Respir Med. 2021 Aug;184:106471. doi: 10.1016/j.rmed.2021.106471. Epub 2021 May 15.
The mortality risk attributable to the classifications of chronic obstructive pulmonary disease (COPD) remains unclear. We investigated the associations of mortality with COPD classifications and reduced lung function in a large longitudinal cohort in Taiwan.
A total of 388,401 adults (≥25 years of age) were recruited between 1996 and 2016 underwent 834,491 medical examinations including spirometry. We used the Global Initiative for Chronic Obstructive Lung Disease (GOLD) to establish the COPD classifications. A time-dependent Cox regression model was used to investigate the associations between the morality risk and COPD classifications. We also examined the associations between mortality and lung function.
The mean age of the participants was 42.1 years, and the median follow-up duration was 16.2 years. We identified 28,283 natural-cause deaths, and the mortality rate was 4.7 per 1,000 person-years. The hazard ratios (HRs) [95%confidence interval (95%CI)] of mortality in the participants with restrictive spirometry pattern and COPD GOLD Ⅰ-Ⅳ were 1.31 (1.27-1.35), 1.18 (1.00-1.39), 1.43 (1.35-1.51), 1.78 (1.66-1.90), and 2.13 (1.94-2.34), respectively, with reference to the participants with normal lung function. The natural-cause mortality risk increased by 33% [HR(95%CI): 1.33 (1.28-1.39)] for participants with COPD. Reduced lung function was also associated with a higher mortality risk.
A more advanced classification of COPD was associated with a greater increase in the mortality risk. Our study suggests that early detection of COPD and slowing the disease progress in patients with COPD are crucial for mortality prevention.
慢性阻塞性肺疾病（COPD）分类的死亡率风险尚不清楚。我们在台湾的一个大型纵向队列中研究了死亡率与 COPD 分类和肺功能降低的关系。
共有 388401 名成年人（≥25 岁）于 1996 年至 2016 年期间接受了 834491 次包括肺活量测定在内的体检。我们使用全球慢性阻塞性肺疾病倡议（GOLD）来确定 COPD 分类。使用时间依赖性 Cox 回归模型来研究死亡率与 COPD 分类之间的关系。我们还检查了死亡率与肺功能之间的关系。
参与者的平均年龄为 42.1 岁，中位随访时间为 16.2 年。我们确定了 28283 例自然原因死亡，死亡率为每 1000 人年 4.7 例。在有限制性肺通气模式和 COPD GOLD Ⅰ-Ⅳ的参与者中，死亡率的危险比（HR）[95%置信区间（95%CI）]分别为 1.31（1.27-1.35）、1.18（1.00-1.39）、1.43（1.35-1.51）、1.78（1.66-1.90）和 2.13（1.94-2.34），与肺功能正常的参与者相比。患有 COPD 的参与者的自然原因死亡率风险增加了 33%[HR（95%CI）：1.33（1.28-1.39）]。肺功能降低也与更高的死亡率风险相关。
更先进的 COPD 分类与死亡率风险的增加有关。我们的研究表明，早期发现 COPD 并减缓 COPD 患者的疾病进展对于预防死亡至关重要。
