Huang Ke, Zheng Zhoude, Li Wei, Niu Hongtao, Lei Jieping, Dong Fen, Yang Ting, Wang Chen
National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China.
Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China.
Lancet Reg Health West Pac. 2023 Oct 13;42:100937. doi: 10.1016/j.lanwpc.2023.100937. eCollection 2024 Jan.
An increase in the prevalence of comorbidities has been reported in patients with chronic obstructive pulmonary disease (COPD). However, contemporary estimates of the overall prevalence of the sociodemographic correlates of COPD comorbidities are scarce and inconsistent in China. This study aimed to investigate the prevalence of sociodemographic correlates of comorbidities in patients with COPD across China.
This was a cross-sectional study. We used data from the Enjoying Breathing Program between May 2020 and April 2022. Participants with COPD from 17 provinces (or equivalent) were included. Comorbidity clusters were stratified based on the number of comorbidities per person. Univariable and multivariable analyses were used to determine the sociodemographic associations of patients with COPD with specific clusters of comorbidities after adjusting for age, sex, and other prespecified covariates. Tetrachoric correlation analyses were performed to determine the associations between specific comorbidities.
A total of 3913 participants with COPD were included, of whom 1744 (44.7%) had at least one comorbidity; 25.4% had one comorbid disease, 12.9% had two, and 6.4% had three or more concurrent diseases. The most common comorbidities were hypertension (17.8%), asthma (9.9%), bronchiectasis (8.2%), diabetes (8.2%), and coronary artery disease (7.7%). In the logistic regression models adjusted for a broad set of factors, patients with COPD residing in the east region of China and having health insurance experienced a decreased likelihood of comorbidities (from OR = 0.70 [95% confidence interval [CI], 0.53-0.93] to OR = 0.50 [95% CI, 0.25-0.99]). However, patients over 80 years had increased risk (OR 1.43 [95% CI 1.01-2.03]), as did those in all Modified Medical Research Council (mMRC) grade categories (grade 1: OR = 1.30 [95% CI, 1.02-1.65]; grade 2: OR = 1.39 [95% CI, 1.07-1.8]; grade 3: OR = 1.67 [95% CI, 1.23-2.26]; and grade 4: OR = 1.81 [95% CI, 1.00-3.28]) and in Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2 classification (OR = 1.30 [95% CI, 1.03-1.65]) relative to their respective references. The associations observed in these subgroups were consistent regardless of the number of comorbidities per person. Tetrachoric correlations demonstrated negative associations in pairwise comparisons of the top five comorbidities, ranging from -0.03 to -0.31 (p < 0.001 in all groups).
In China, comorbidities are highly prevalent among patients with COPD, with older age, higher mMRC grade, and lung function decline being the major risk factors. Studies with larger sample sizes are required to elucidate the complex mechanisms underlying COPD comorbidities.
This study was funded by CAMS Innovation Fund for Medical Sciences (CIFMS) (2021-I2M-1-049 and 2022-I2M-C&T-B-107).
据报道，慢性阻塞性肺疾病（COPD）患者的合并症患病率有所增加。然而，在中国，关于COPD合并症社会人口学相关因素总体患病率的当代估计较少且不一致。本研究旨在调查中国COPD患者合并症社会人口学相关因素的患病率。
这是一项横断面研究。我们使用了2020年5月至2022年4月期间“畅享呼吸计划”的数据。纳入了来自17个省（或相当于省）的COPD患者。合并症集群根据每人合并症的数量进行分层。在调整年龄、性别和其他预先指定的协变量后，使用单变量和多变量分析来确定COPD患者与特定合并症集群的社会人口学关联。进行四分相关分析以确定特定合并症之间的关联。
共纳入3913例COPD患者，其中1744例（44.7%）至少有一种合并症；25.4%有1种合并症，12.9%有2种，6.4%有3种或更多种并发疾病。最常见的合并症是高血压（17.8%）、哮喘（9.9%）、支气管扩张（8.2%）、糖尿病（8.2%）和冠状动脉疾病（7.7%）。在调整了一系列广泛因素的逻辑回归模型中，居住在中国东部地区且有医疗保险的COPD患者合并症的可能性降低（从OR = 0.70 [95%置信区间[CI]，0.53 - 0.93]降至OR = 0.50 [95% CI，0.25 - 0.99]）。然而，80岁以上的患者风险增加（OR 1.43 [95% CI 1.01 - 2.03]），所有改良医学研究委员会（mMRC）分级类别（1级：OR = 1.30 [95% CI，1.02 - 1.65]；2级：OR = 1.39 [95% CI，1.07 - 1.8]；3级：OR = 1.67 [95% CI，1.23 - 2.26]；4级：OR = 1.81 [9
