title: Impact of co-morbidities on self-rated health in self-reported COPD: an analysis of NHANES 2001-2008.
abstract: Chronic Obstructive Pulmonary Disease (COPD) coexists with co-morbidities. While co-morbidity has been associated with poorer health status, it is unclear which conditions have the greatest impact on self-rated health. We sought to determine which, and how much, specific co-morbid conditions impact on self-rated health in current and former smokers with self-reported COPD. Using the 2001-2008 National Health and Nutrition Examination Survey we characterized the association between thirteen co-morbidities and health status among individuals self-reporting COPD. Adjusted odds ratios (ORs) were generated using ordinal logistic regression. Additionally we evaluated the impact of increasing number of co-morbidities with self-rated health. Eight illnesses had significant associations with worse self-rated health, however after mutually adjusting for these conditions, congestive heart failure (OR 3.07, 95% CI 1.69-5.58), arthritis (OR 1.69, 95% CI 1.13-2.52), diabetes (OR 1.63, 95% CI 1.01-2.64), and incontinence/prostate disease (OR 1.63, 95% CI 1.01-2.62) remained independent predictors of self-rated health. Each increase in co-morbidities was associated with a 43% higher chance of worse self-rated health (95% CI 1.27-1.62). Individuals with COPD have a substantial burden of co-morbidity, which is associated with worse self-rated health. CHF, arthritis, diabetes and incontinence/prostate disease have the most impact on self-rated health. Targeting these co-morbidities in COPD may result in improved self-rated health.
authors.affiliation: Johns Hopkins School of Medicine, Department of Medicine, Division of Pulmonary and Critical Care Medicine, Baltimore, Maryland 21224, USA. nputcha1@jhmi.edu
authors.forename: Nirupama
authors.initials: N
authors.lastname: Putcha
authors.forename: Milo A
authors.initials: MA
authors.lastname: Puhan
authors.forename: Nadia N
authors.initials: NN
authors.lastname: Hansel
authors.forename: M Brad
authors.initials: MB
authors.lastname: Drummond
authors.forename: Cynthia M
authors.initials: CM
authors.lastname: Boyd
mesh_terms: D000368:Aged; D001168:Arthritis / Q000453:epidemiology*; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology*; D005260:Female; D006304:Health Status; D006333:Heart Failure / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys; D015995:Prevalence; D011469:Prostatic Diseases / Q000453:epidemiology*; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology*; D057566:Self Report; D014549:Urinary Incontinence / Q000453:epidemiology*