Background
Methods
Design and dataset
Study population
Comorbidities
Outcomes
Statistical analysis
Results
Study population
Patients with full follow-up (study population)a
(n = 14,603) | Subgroups of study population | ||
---|---|---|---|
Patient characteristics | Patients with <2 exacerbations/year (n = 13,709) | Patients with ≥2 exacerbations/year (n = 894)b
| |
Sex, male, n (%) | 7,749 (53 · 1) | 7,322 (53 · 4) | 427 (47 · 8)‡
|
Age at study baseline, years; mean (SD; range) | 66 · 5 (11 · 5; 40–110)‡
| 66 · 5 (11 · 6; 40–110) | 67 · 4 (10 · 3; 40–93)‡
|
Full dataset available (censored data), n (%) | |||
Full data available | 13,709 (93 · 9) | 894 (6 · 1) | |
Deceased | N/A | N/A | N/A |
Moved | N/A | N/A | N/A |
Nursing home | N/A | N/A | N/A |
Unknown | N/A | N/A | N/A |
Comorbidity data | |||
Number of comorbid diseasesc, mean (SD; range) | 3 · 0 (2 · 3;0–20)‡
| 3 · 0 (2 · 3;0–16) | 3 · 4 (2 · 5; 0–20)‡
|
Number of comorbid diseases categoriesc, n (%) | |||
0 | 1,777 (12 · 2) | 1,700 (12 · 4) | 77 (8 · 6) |
1 or 2 | 5,305 (36 · 6) | 5,021 (36 · 6) | 284 (31 · 8) |
3 or 4 | 4,258 (29 · 2) | 3,977 (29 · 0) | 281 (31 · 4) |
5 and more | 3,263 (22 · 3)‡
| 3,011 (22 · 0) | 252 (28 · 2)‡
|
Exacerbations | |||
Number of exacerbationsd, mean (SD; range) | 0 · 75 (1 · 5;0–15)‡
| 0 · 44 (0 · 8;0–2) | 5 · 6 (2 · 0;3–15)‡
|
Total study populationa, (n = 14,603) | Patients with <2 exacerbations/year, (n = 13,709) | Patients with ≥2 exacerbations/year, (n = 894) |
p-valueb
| |
---|---|---|---|---|
Frequent comorbidity | ||||
Hypertension | 5,116 (35 · 0) | 4,805 (35 · 2) | 311 (34 · 8) | 0 · 873 |
Coronary heart disease | 2,759 (18 · 9) | 2,569 (18 · 7) | 191 (21 · 4) | 0 · 051 |
Osteoarthritis | 2,570 (17 · 6) | 2,402 (17 · 5) | 168 (18 · 8) | 0 · 334 |
Diabetes | 2,464 (16 · 9) | 2,330 17 · 0) | 134 (15 · 0) | 0 · 120 |
Peripheral vascular disease | 2,031 (13 · 9) | 1,897 (14 · 8) | 150 (16 · 8) |
0 · 006
|
Blindness & low vision | 1,938 (13 · 3) | 1,772 (12 · 9) | 166 (18 · 6) |
<0 · 001
|
Dyspepsia, gastroesophageal reflux | 1,845 (12 · 6) | 1,703 (12 · 4) | 142 (15 · 9) |
0 · 003
|
Dislipidemia | 1,703 (11 · 7) | 1,613 (11 · 8) | 90 (10 · 1) | 0 · 125 |
Stroke & transient ischaemic attack | 1,357 (9 · 3) | 1,259 (9 · 2) | 98 (11 · 0) | 0 · 076 |
Chronic kidney diease | 1,360 (9 · 3) | 1,263 (9 · 2) | 97 (10 · 9) | 0 · 103 |
Asthma | 1,305 (8 · 9) | 1,202 (8 · 8) | 103 (11 · 5) |
0 · 005
|
Hearing loss | 1,144 (7 · 8) | 1,078 (7 · 9) | 66 (7 · 4) | 0 · 604 |
Heart failure | 1,048 (7 · 2) | 943 (6 · 9) | 105 (11 · 7) |
<0 · 001
|
Atrial fibrillation | 1,044 (7 · 1) | 964 (7 · 0) | 80 (8 · 9) | 0 · 031 |
Skin cancer | 913 (6 · 3) | 862 (6 · 3) | 51 (5 · 7) | 0 · 485 |
Osteoporosis/osteopenia | 884 (6 · 1) | 801 (5 · 8) | 83 (9 · 3) |
<0 · 001
|
Thyroid disorder | 808 (5 · 5) | 757 (5 · 5) | 51 (5 · 9) | 0 · 817 |
Depression | 800 (5 · 5) | 729 (5 · 3) | 71 (7 · 9) |
0 · 001
|
Prostate disorders | 784 (5 · 4) | 719 (5 · 2) | 65 (7 · 3) |
0 · 009
|
Cardiopulmonary comorbidity | ||||
Heart valve disease | 568 (3 · 9) | 528 (3 · 9) | 40 (7 · 8) |
0 · 035
|
Bronchiectasis/chronic bronchitis | 414 (2 · 8) | 379 (2 · 8) | 35 (3 · 9) | 0 · 045 |
Pulmonary cancer | 317 (2 · 2) | 284 (2 · 1) | 33 (3 · 7) |
0 · 001
|
Sleep apneu syndrome | 173 (1 · 2) | 161 (1 · 2) | 12 (1 · 3) | 0 · 653 |
Other chronic pulmonary disease | 157 (1 · 1) | 148 (1 · 1) | 9 (1 · 0) | 0 · 838 |
Recurrent sinusitis | 54 (0 · 4) | 49 (0 · 4) | 55 (6 · 2) | 0 · 335 |
Congenital cardiovascular anomaly | 32 (0 · 2) | 28 (0 · 2) | 4 (0 · 4) | 0 · 132 |
Study populationa, (n = 14,603) | Patients with <2 exacerbations/year, (n = 13,709) | Patients with ≥2 exacerbations/year (n = 894) |
p-valueb
| |
---|---|---|---|---|
Comorbidity category | ||||
Cardiovascular | 8,516 (58 · 3) | 7,955 (58 · 0) | 561 (62 · 8) | 0 · 006 |
Endocrine, metabolic and nutrition | 4,856 (33 · 3) | 4,568 (33 · 3) | 288 (25 · 5) | 0 · 496 |
Musculoskeletal | 3,588 (24 · 6) | 3,337 (24 · 3) | 251 (28 · 1) | 0 · 012 |
Eye and ear | 2,984 (20 · 4) | 2,762 (20 · 1) | 222 (24 · 8) | 0 · 001 |
Digestive | 2,801 (19 · 2) | 2,597 (18 · 9) | 204 (22 · 8) | 0 · 004 |
Urogenital (male and female) | 2,330 (16 · 0) | 2,146 (15 · 7) | 184 (20 · 6) | <0 · 001 |
Psychiatric | 2,271 (15 · 6) | 2,092 (15 · 3) | 179 (20 · 0) | <0 · 001 |
Non-pulmonary cancer | 2,203 (15 · 1) | 2,071 (15 · 1) | 132 (14 · 8) | 0 · 782 |
Respiratory (excl · pulmonary cancer) | 1,998 (13 · 7) | 1,839 (13 · 4) | 159 (17 · 8) | <0 · 001 |
Skin | 1,395 (9 · 6) | 1,314 (9 · 6) | 81 (9 · 1) | 0 · 605 |
Neurological | 413 (2 · 8) | 389 (2 · 8) | 24 (2 · 7) | 0 · 789 |
Pulmonary cancer | 317 (2 · 2) | 284 (2 · 1) | 33 (3 · 7) | 0 · 001 |
Blood (forming organs) and lymphatics | 106 (0 · 7) | 97 (0 · 7) | 9 (1 · 0) | 0 · 307 |
Infectious | 87 (0 · 6) | 80 (0 · 6) | 7 (0 · 8) | 0 · 453 |
Associations between comorbidities and exacerbation frequency
Odds ratio (95%CI) |
p-value | |
---|---|---|
Comorbid conditionsa, b
| ||
Heart failure | 1 · 72 (1 · 38–2 · 14) | <0 · 001 |
Blindness & low vision | 1 · 46 (1 · 21–1 · 75) | <0 · 001 |
Pulmonary cancer | 1 · 85 (1 · 28–2 · 67) | 0 · 002 |
Depression | 1 · 48 (1 · 14–1 · 91) | 0 · 003 |
Prostate disorders | 1 · 50 (1 · 13–1 · 98) | 0 · 004 |
Asthma | 1 · 36 (1 · 11–1 · 70) | 0 · 004 |
Osteoporosis/osteopenia | 1 · 41 (1 · 11–1 · 80) | 0 · 006 |
Diabetes | 0 · 80 (0 · 66–0 · 97) | 0 · 020 |
Dyspepsia, gastroesophageal reflux | 1 · 25 (1 · 03–1 · 50) | 0 · 023 |
Peripheral vascular disease | 1 · 20 (1 · 00–1 · 45) | 0 · 049 |
Comorbidity categoriesb,c
| ||
Respiratory (excl. pulmonary cancer) | 1 · 37 (1 · 15–1 · 64) | <0 · 001 |
Psychiatric | 1 · 35 (1 · 13–1 · 60) | <0 · 001 |
Urogenital (male and female) | 1 · 34 (1 · 12–1 · 60) | <0 · 001 |
Eye and ear | 1 · 25 (1 · 06–1 · 47) | 0 · 007 |
Endocrine, metabolic and feeding | 0 · 85 (0 · 73–0 · 99) | 0 · 032 |
Cardiovascular | 1 · 17 (1 · 01–1 · 36) | 0 · 037 |
Time to first exacerbation
Cox hazard ratio (95% CI) |
p-value | |
---|---|---|
Comorbiditya,b
| ||
Bronchiectasis/chronic bronchitis | 1 · 50 (1 · 31–1 · 73) | <0 · 001 |
Heart failure | 1 · 41 (1 · 29–1 · 55) | <0 · 001 |
Depression | 1 · 34 (1 · 20–1 · 50) | <0 · 001 |
Atrial fibrillation | 1 · 27 (1 · 16–1 · 40) | <0 · 001 |
Asthma | 1 · 24 (1 · 14–1 · 36) | <0 · 001 |
Peripheral vascular disease | 1 · 15 (1 · 07–1 · 24) | <0 · 001 |
Prostate disorders | 1 · 20 (1 · 04–1 · 45) | 0 · 002 |
Blindness & low vision | 1 · 11 (1 · 03–1 · 20) | 0 · 009 |
Coronary heart disease | 1 · 10 (1 · 02–1 · 17) | 0 · 011 |
Dyspepsia, gastroesophageal reflux | 1 · 10 (1 · 02–1 · 20) | 0 · 013 |
Pulmonary cancer | 1 · 23 (1 · 04–1 · 45) | 0 · 016 |
Recurrent sinusitis | 1 · 53 (1 · 05–2 · 24) | 0 · 028 |
Osteoporosis/osteopenia | 1 · 12 (1 · 01–1 · 25) | 0 · 037 |
Comorbidity categoryb, c
| ||
Respiratory (excl. pulmonary cancer) | 1 · 26 (1 · 17–1 · 36) | <0 · 001 |
Urogenital (male and female) | 1 · 18 (1 · 10–1 · 27) | <0 · 001 |
Cardiovascular | 1 · 16 (1 · 08–1 · 24) | <0 · 001 |
Mental health | 1 · 16 (1 · 08–1 · 24) | <0 · 001 |
Eye and ear | 1 · 09 (1 · 02–1 · 16) | 0 · 013 |
Digestive | 1 · 07 (1 · 00–1 · 15) | 0 · 042 |