Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark.
BMJ Open Respir Res. 2023 Oct;10(1). doi: 10.1136/bmjresp-2023-001798.
Comorbidities are common in patients with chronic obstructive pulmonary disease (COPD). Estimates of prevalence, incidence and prognostic impact of comorbidities provide foundational knowledge of COPD epidemiology. We examined the prevalence, incidence and prognostic impact of 21 comorbidities among patients with COPD compared with the Danish general population.
We conducted a nationwide, population-based cohort study based on longitudinal Danish registry data, covering all Danish hospitals (2010-2021). The cohorts comprised 142 973 patients with a first-time hospital-based diagnosis of COPD and 428 917 age-matched and sex-matched comparators from the general population. During follow-up, we estimated the 5-year risk and risk difference, using competing risk methods when applicable.
At time of diagnosis, the comorbidities with the highest prevalence were mood, stress-related or anxiety disorders (25.2% for patients with COPD vs 13.1% for comparators), osteoporosis/hip fractures (17.4% vs 9.9%), diabetes (15.6% vs 10.5%), peripheral arterial disease (13.5% vs 4.9%) and heart failure (13.3% vs 4.0%). During follow-up, the risk of most incident comorbidities was markedly elevated among patients with COPD. The five comorbidities associated with the highest 5-year absolute risk difference with respect to the risk in the general population were mood, stress-related or anxiety disorders (5.7%), osteoporosis/hip fractures (5.6%), heart failure (4.2%), smoking-related cancers (2.8%) and peripheral arterial disease (2.7%). The 5-year mortality risk was 43% vs 17.7%. Among patients with COPD, the 5-year mortality risk markedly increased with the number of comorbidities present.
Our population-based findings underscore the importance of considering comorbidities in the management of COPD.
慢性阻塞性肺疾病（COPD）患者常合并多种疾病。对合并症的患病率、发病率和预后影响的评估为 COPD 流行病学提供了基础认识。我们研究了与丹麦普通人群相比，COPD 患者中 21 种合并症的患病率、发病率和预后影响。
我们开展了一项基于丹麦纵向登记数据的全国性、基于人群的队列研究，涵盖了所有丹麦医院（2010-2021 年）。队列包括 142973 例首次在医院确诊的 COPD 患者和 428917 例年龄和性别匹配的普通人群对照者。在随访期间，我们使用竞争风险方法估计了 5 年风险和风险差异，在适用时使用竞争风险方法。
在诊断时，患病率最高的合并症是情绪、应激相关或焦虑障碍（25.2%的 COPD 患者 vs 13.1%的对照者）、骨质疏松/髋部骨折（17.4% vs 9.9%）、糖尿病（15.6% vs 10.5%）、外周动脉疾病（13.5% vs 4.9%）和心力衰竭（13.3% vs 4.0%）。在随访期间，COPD 患者发生大多数新发合并症的风险显著升高。与普通人群相比，与 5 年绝对风险差异相关的最高的五种合并症是情绪、应激相关或焦虑障碍（5.7%）、骨质疏松/髋部骨折（5.6%）、心力衰竭（4.2%）、与吸烟相关的癌症（2.8%）和外周动脉疾病（2.7%）。5 年死亡率为 43% vs 17.7%。在 COPD 患者中，随着合并症数量的增加，5 年死亡率显著升高。
我们的基于人群的研究结果强调了在 COPD 管理中考虑合并症的重要性。
