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Observational Study
. 2025 Jun 27:20:2117-2130.
doi: 10.2147/COPD.S488701. eCollection 2025.

Comorbidities and Cause of Death in COPD Patients Compared to Non-COPD Controls: An 8-year Observational Retrospective Healthcare Claims Database Cohort Study

Claus F Vogelmeier  1 , Felix W Friedrich  2 , Patrick Timpel  3 , Nils Kossack  3 , Joanna Diesing  3 , Marc Pignot  4 , Melanie Abram  2 , Michael Gediga  2 , Marija Halbach  2
Affiliations
Observational Study

Comorbidities and Cause of Death in COPD Patients Compared to Non-COPD Controls: An 8-year Observational Retrospective Healthcare Claims Database Cohort Study

Claus F Vogelmeier et al. Int J Chron Obstruct Pulmon Dis. .

Abstract

Purpose: Patients with COPD suffer from various comorbidities, seemingly leading to a collective increase in morbidity and mortality. However, comorbidities with COPD have been largely unreported.

Patients and methods: Using healthcare claims data, only the deceased among around 250,000 COPD patients diagnosed in 2011-2018 were evaluated by cause of death (cumulative incidence without competing risk) across a period of up to eight years. Results were compared with 1:1 propensity score-matched controls. Additionally, the prevalence of comorbidities in deceased patients was compared.

Results: On average, deceased COPD patients and matched controls lived to be 75.7 and 78.0 years, respectively, and COPD patients had more comorbidities prior to death (mean 4.53 and 3.65). Both respiratory and cardiovascular-related deaths were more likely in COPD patients than in their matched controls (3.3 and 1.6 percentage points higher after eight years), and this was more extreme (9.8 and 3.4 percentage points higher, respectively) in the COPD subgroup with multiple/severe exacerbations; cumulative incidence of death increased with increasing COPD severity. Comorbidity prevalence, especially cardiovascular-related, was higher in COPD patients than in matched controls; COPD patients had a 42% higher risk of heart failure (RR 1.42; 1.38-1.47), 30% higher risk of ischemic heart disease (RR 1.30; 1.25-1.35), and 27% increased risk of atrial fibrillation (RR 1.27; 1.21-1.32).

Conclusion: In this real-world observational retrospective cohort study, we found patients with COPD died at a younger age, and developed more comorbidities, than matched controls.

Keywords: cardiovascular death; cardiovascular disease; exacerbations; mortality; multimorbidity; respiratory death.

Plain language summary

People affected by COPD have other health issues. We studied a cohort of deceased insurees, comparing the health status of those with, to those without COPD, before death. The database had data from 250,000 COPD patients, over a period of up to eight years. More people with COPD died from respiratory or heart-related causes. They also died younger and had more additional health issues, compared to the non-COPD cohort, regardless of cause of death. The COPD cohort had higher rates of asthma, pneumonia, various heart conditions, dementia, depression, cancer, and osteoporosis, compared to the non-COPD cohort; they were more likely to have these comorbidities diagnosed particularly before death. For example, the risk of pneumonia, atrial fibrillation, and heart failure was up to 83% higher in the COPD cohort. The risk of depression was also 78% higher in those with COPD than in the cohort without COPD. This information shows a clear link between COPD and other health issues, especially those related to the lungs and heart. Treatment guidelines for COPD patients should target multiple health issues at once.

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Conflict of interest statement

JD, PT, and NK are employees of WIG2 GmbH. WIG2 was contracted by AstraZeneca to support designing the study, run the analyses and develop/adapt the manuscript draft. MP is an employee of ZEG Berlin GmbH. ZEG Berlin was contracted by AstraZeneca to support managing and designing the study. FWF, MA, and MH are employed by AstraZeneca. CFV reports grants and/or personal fees from Aerogen, AstraZeneca, Boehringer Ingelheim, CSL Behring, Chiesi, GlaxoSmithKline, Grifols, Insmed, Menarini, Novartis, Nuvaira, MedUpdate, Aerogen, Sanofi, and Roche outside the submitted work. The authors report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
Study Design. The index date was defined as the first COPD diagnosis recorded after 01 January 2011 and was not considered part of the baseline period. A minimum of 12 months of data prior to the index date (baseline, blue line) as well as a minimum of 12 months of subsequent follow-up period (observation period, blue line) for the study cohort starting at the index date was required. The 12 months prior to death used for analysis is represented by the green line. (Source: Own presentation).
Figure 2
Figure 2
Difference (pp) of cumulative incidence of respiratory-related death between COPD and matched controls across follow-up, stratified by exacerbation subgroup.
Figure 3
Figure 3
Cumulative incidence of death by cause of death category (respiratory-, CV-, and cancer-related), for each exacerbation subgroup (A with 0 pre-index exacerbations; B with 1 moderate pre-index exacerbation; C/D with ≥ 2 moderate and/or ≥ 1 severe pre-index exacerbation(s)).
See this image and copyright information in PMC

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