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. 2017 Feb 6;18(1):31.
doi: 10.1186/s12931-017-0512-2.

Associations between chronic comorbidity and exacerbation risk in primary care patients with COPD

Janine A M Westerik  1 , Esther I Metting  2 , Job F M van Boven  2 , Waling Tiersma  1 , Janwillem W H Kocks  2 , Tjard R Schermer  3
Affiliations

Associations between chronic comorbidity and exacerbation risk in primary care patients with COPD

Janine A M Westerik et al. Respir Res. .

Abstract

Background: COPD often coexists with chronic conditions that may influence disease prognosis. We investigated associations between chronic (co)morbidities and exacerbations in primary care COPD patients.

Method: Retrospective cohort study based on 2012-2013 electronic health records from 179 Dutch general practices. Comorbidities from patients with physician-diagnosed COPD were categorized according to International Classification of Primary Care (ICPC) codes. Chi-squared tests, uni- and multivariable logistic, and Cox regression analyses were used to study associations with exacerbations, defined as oral corticosteroid prescriptions.

Results: Fourteen thousand six hundred three patients with COPD could be studied (mean age 67 (SD 12) years, 53% male) for two years. At baseline 12,826 (88%) suffered from ≥1 comorbidities, 3263 (22%) from ≥5. The most prevalent comorbidities were hypertension (35%), coronary heart disease (19%), and osteoarthritis (18%). Several comorbidities showed statistically significant associations with frequent (i.e., ≥2/year) exacerbations: heart failure (odds ratio [OR], 95% confidence interval: 1.72; 1.38-2.14), blindness & low vision (OR 1.46; 1.21-1.75), pulmonary cancer (OR 1.85; 1.28-2.67), depression 1.48; 1.14-1.91), prostate disorders (OR 1.50; 1.13-1.98), asthma (OR 1.36; 1.11-1.70), osteoporosis (OR 1.41; 1.11-1.80), diabetes (OR 0.80; 0.66-0.97), dyspepsia (OR 1.25; 1.03-1.50), and peripheral vascular disease (OR 1.20; 1.00-1.45). From all comorbidity categories, having another chronic respiratory disease beside COPD showed the highest risk for developing a new exacerbation (Cox hazard ratio 1.26; 1.17-1.36).

Conclusion: Chronic comorbidities are highly prevalent in primary care COPD patients. Several chronic comorbidities were associated with having frequent exacerbations and increased exacerbation risk.

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Figures

Fig. 1
Fig. 1
Comorbidome of comorbidities in the COPD study population (n = 14,603). Results are from univariable (upper panel) and multivariable (lower panel, corrected for age, gender and the other comorbidities) logistic regression analysis. (Diameter of the coloured circles represents the prevalence of each comorbidity. Proximity to the black centre of the circle represents stronger positive association (OR) with ≥2 exacerbation per year. The dashed circle represents an OR of 1. Comorbidities marked bold were statistically significantly (i.e., p < 0.05) associated with increased or decreased risk. In the multivariable model covariates were sequentially dropped until only statistically significant covariates remained. Comorbidities outside the dashed circle were negatively associated (i.e., ‘protective’) with ≥2 exacerbation/year. Comorbidities with prevalence <5% were not analysed). CKD: chronic kidney disease. COPD: chronic obstructive pulmonary disease. GERD: gastroesophageal reflux disease. TIA: transient ischemic attack
Fig. 2
Fig. 2
Hazard for exacerbation split by COPD patients with versus without one or more diagnoses of other chronic respiratory diseases at baseline. (Patients with another chronic respiratory disease next to their COPD showed a higher hazard rate for the development of a first exacerbation (Cox hazard ratio 1.26; 1.17–1.36) compared to patients without another chronic respiratory disease). COPD: chronic obstructive pulmonary disease
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