| アブストラクト | BACKGROUND: Identifying correlates of cause-specific mortality in patients with chronic obstructive pulmonary disease (COPD) may aid the targeting of therapies to reduce mortality. We determined factors associated with causes of death in a primary care COPD population. METHODS: Clinical Practice Research Datalink Aurum was linked to Hospital Episode Statistics and death certificate data. People with COPD alive between 1 January 2010 and 1 January 2020 were included. Patient characteristics were defined before the start of follow-up: (a) frequency and severity of exacerbations; (b) emphysema or chronic bronchitis; (c) Global Obstructive Lung Disease (GOLD) groups A-D; and (d) airflow limitation. We used Cox Proportional Hazards regression and competing risks to investigate the association between patient characteristics and risk of all-cause, COPD and cardiovascular (CV) mortality. RESULTS: 339 647 people with COPD were included of which 97 882 died during follow-up (25.7% COPD related and 23.3% CV related). Airflow limitation, GOLD group, exacerbation frequency and severity, and COPD phenotype were associated with all-cause mortality. Exacerbations, both increased frequency and severity, were associated with COPD-related mortality (>/=2 exacerbations vs none adjusted HR: 1.64, 1.57-1.71; 1 severe vs none adjusted HR: 2.17, 2.04-2.31, respectively). Patients in GOLD groups B-D had a higher risk of COPD and CV mortality compared with GOLD group A (GOLD group D vs group A, adjusted HR for COPD mortality: 4.57, 4.23-4.93 and adjusted HR for CV mortality: 1.53, 1.41-1.65). Increasing airflow limitation was also associated with both COPD and CV mortality (GOLD 4 vs 1, adjusted HR: 12.63, 11.82-13.51 and adjusted HR: 1.75, 1.60-1.91, respectively). CONCLUSION: Poorer airflow limitation, worse functional status and exacerbations had substantial associations with risk of all-cause mortality. Differing results for CV and COPD-related mortality suggests interventions to prevent mortality may need to target particular characteristics or time points in the disease course. |
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| 組織名 | School of Public Health and National Heart and Lung Institute, Imperial College;London, London, UK h.whittaker@imperial.ac.uk.;Department of Epidemiology, Value Evidence and Outcomes, Global Medical R&D,;GlaxoSmithKline Plc, Brentford, UK.;London, London, UK. |
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