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 Halbach2 1Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-Universität Marburg, German Center for Lung Research (DZL), Marburg, Hessen, Germany; 2AstraZeneca GmbH, Hamburg, Germany; 3WIG2 GmbH Scientific Institute for Health Economics and Health System Research, Leipzig, Saxony, Germany; 4ZEG – Center for Epidemiology and Health Research Berlin GmbH, Berlin, GermanyCorrespondence: Michael Gediga, AstraZeneca GmbH, Friesenweg 26, Hamburg, 22763, Germany, Email [email protected]: 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.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.Keywords: exacerbations, mortality, cardiovascular disease, respiratory death, cardiovascular death, multimorbidity