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).

A nationwide cohort study of patients with a first-time hospital-based diagnosis of COPD and age- and sex-matched individuals from the general population in Denmark found that mood, stress-related or anxiety disorders (25.2% for patients with COPD vs 13.1% for comparators), osteoporosis/hip fractures (17.4% vs 9.9%), diabetes (15.6% vs 10.5%), peripheral arterial disease (13.5% vs 4.9%), and heart failure (13.3% vs 4.0%) were the comorbidities with the highest prevalence in the COPD group (Skajaa 2023) [evidence level III-2]. The 5- year mortality was 58% in patients with COPD with 4 or more comorbidities, compared to 7% with no comorbidities (Skajaa 2023).

A population-based cohort study in Ontario, Canada using linked datasets and including all patients aged 35 years or older living in Ontario who underwent intermediate to high-risk elective non-cardiac surgeries from April 2005 to March 2019, found that patients with COPD had lower survival and greater health care costs in the year after scheduled surgery than patients without COPD. Within 30  days after surgery, patients with COPD were more likely to die (n  =  5873, 3.4%) than those without (n  =  9429, 1.2%) (Sankar 2023) [evidence level III-2]. Perioperative patient care should include comprehensive assessment and treatment tailored not only to COPD, but also to management of concomitant conditions and surgical disease.