Ke Yalei, Zhao Yuxuan, Sun Dianjianyi, Pei Pei, Du Huaidong, Chen Yiping, Yang Ling, Yang Xiaoming, Chen Yalin, Chen Junshi, Chen Zhengming, Lv Jun, Li Liming, Yu Canqing
Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, 38 Xueyuan Road, Beijing, 100191, China.
Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing, 100191, China.
Eur J Epidemiol. 2025 Jun 4. doi: 10.1007/s10654-025-01252-7.
The prevalence of chronic obstructive pulmonary disease (COPD) is rising in China, yet population-based evidence on COPD-related mortality risk remains limited. This study examined the association between prevalent COPD and all-cause and cause-specific mortality in a large Chinese cohort. 484,301 adults aged 30 to 79 years who received spirometry at the baseline of the China Kadoorie Biobank Study (2004-2008) were included. COPD was defined as FEV/ FVC < 0.7. Mortality data were tracked via local death registries and national health insurance systems over a median follow-up period of 16.0 years. Cox proportional hazard models and competing risk regression were used to estimate hazard ratios (HRs) and subdistribution HRs (SHRs), respectively. The COPD group had higher all-cause and cause-specific mortality, with adjusted HR (95%CI) for all-cause mortality of 1.44 (1.41-1.47), and adjusted SHR (95%CI) of 1.09 (1.05-1.13), 1.06 (1.01-1.11), 3.30 (3.12-3.49), 1.45 (1.16-1.81), for circulatory disease, neoplasms, respiratory disease, and infectious disease mortality, respectively. Specifically, young COPD (aged < 50 years) showed a stronger mortality association than those aged ≥ 50 years. Moreover, individuals with preserved ratio impaired spirometry (PRISm) had a 1.4-fold higher risk of all-cause mortality compared with non-COPD participants. COPD is associated with a significantly elevated risk of mortality from all causes, circulatory disease, neoplasms, respiratory disease, and infectious disease in the Chinese population. Additionally, young COPD and those with PRISm faced significant mortality burdens.
慢性阻塞性肺疾病(COPD)在中国的患病率正在上升,但基于人群的COPD相关死亡风险证据仍然有限。本研究调查了中国一个大型队列中现患COPD与全因死亡率和特定病因死亡率之间的关联。纳入了484301名年龄在30至79岁之间、在中国嘉道理生物样本库研究(2004 - 2008年)基线时接受肺活量测定的成年人。COPD定义为FEV/FVC < 0.7。通过当地死亡登记处和国家医疗保险系统追踪死亡率数据,中位随访期为16.0年。分别使用Cox比例风险模型和竞争风险回归来估计风险比(HRs)和亚分布风险比(SHRs)。COPD组的全因死亡率和特定病因死亡率更高,全因死亡率的调整后HR(95%CI)为1.44(1.41 - 1.47),循环系统疾病、肿瘤、呼吸系统疾病和传染病死亡率的调整后SHR(95%CI)分别为1.09(1.05 - 1.13)、1.06(1.01 - 1.11)、3.30(3.12 - 3.49)、1.45(1.16 - 1.81)。具体而言,年轻的COPD患者(年龄 < 50岁)比年龄≥50岁的患者表现出更强的死亡关联。此外,与非COPD参与者相比,肺功能保留比例受损(PRISm)的个体全因死亡风险高1.4倍。在中国人群中,COPD与所有原因、循环系统疾病、肿瘤、呼吸系统疾病和传染病导致的死亡风险显著升高相关。此外,年轻的COPD患者和PRISm患者面临着重大的死亡负担。