O7.1 Increased risks from comorbidities in the presence of COPD

Using a large dataset generated from 311 general practices in the UK, Feary et al (Feary 2010) found COPD was associated with increased risks of cardiovascular disease (OR 4.98, 95% CI 4.85 to 5.81), stroke (OR 3.34, 95% CI 3.21 to 3.48) and diabetes mellitus (OR 2.04, 95% CI 1.97 to 2.12). In the follow-up analyses, after adjusting for confounding by sex and smoking status and stratifying for age, the greatest increase in the rate of acute arteriovascular events was found in the youngest age groups. Further supporting these findings, a prospective study examining in hospital mortality in patients with acute ST segment elevation myocardial infarction found that COPD was a strong independent risk factor for death (6.3% versus 3.4% p=0.006) (Wakabayashi 2010). The most common comorbidities differ between men and women. Specifically women are more likely to demonstrate anxiety and depression than men.(Aryal 2014) [evidence level III-2].  In a cohort study in Spain, COPD was associated with an increased number of comorbidities, occurring at an earlier age (on average 10 to 20 years earlier) compared to non-COPD controls (Divo 2018), suggesting accelerated ageing [evidence level III-2].  A retrospective cohort study of COPD admissions in over 2,000 male US army veterans found that comorbidity was associated with a higher 30 day readmission and mortality rate and with lower rates of corticosteroid and antibiotic use whilst in hospital (Spece 2018).