title: COPD comorbidities network.
abstract: Multimorbidity frequently affects the ageing population and their co-existence may not occur at random. Understanding their interactions and that with clinical variables could be important for disease screening and management.In a cohort of 1969 chronic obstructive pulmonary disease (COPD) patients and 316 non-COPD controls, we applied a network-based analysis to explore the associations between multiple comorbidities. Clinical characteristics (age, degree of obstruction, walking, dyspnoea, body mass index) and 79 comorbidities were identified and their interrelationships quantified. Using network visualisation software, we represented each clinical variable and comorbidity as a node with linkages representing statistically significant associations.The resulting COPD comorbidity network had 428, 357 or 265 linkages depending on the statistical threshold used (p≤0.01, p≤0.001 or p≤0.0001). There were more nodes and links in COPD compared with controls after adjusting for age, sex and number of subjects. In COPD, a subset of nodes had a larger number of linkages representing hubs. Four sub-networks or modules were identified using an inter-linkage affinity algorithm and their display provided meaningful interactions not discernible by univariate analysis.COPD patients are affected by larger number of multiple interlinked morbidities which clustering pattern may suggest common pathobiological processes or be utilised for screening and/or therapeutic interventions.
authors.affiliation: Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA mdivo@partners.org.
authors.forename: Miguel J
authors.initials: MJ
authors.lastname: Divo
authors.affiliation: Pulmonary Department, Hospital Universitario La Candelaria, Universidad de La Laguna, Santa Cruz de Tenerife, Spain.
authors.forename: Ciro
authors.initials: C
authors.lastname: Casanova
authors.affiliation: Respiratory Service, Hospital Universitario Miguel Servet, Zaragoza, Spain.
authors.forename: Jose M
authors.initials: JM
authors.lastname: Marin
authors.affiliation: Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Victor M
authors.initials: VM
authors.lastname: Pinto-Plata
authors.affiliation: Department of Pulmonology, University Clinic of Navarra, Pamplona, Spain.
authors.forename: Juan P
authors.initials: JP
authors.lastname: de-Torres
authors.affiliation: Department of Pulmonology, University Clinic of Navarra, Pamplona, Spain.
authors.forename: Javier J
authors.initials: JJ
authors.lastname: Zulueta
authors.affiliation: Pulmonary Department, Hospital Universitario de Gran Canaria Dr Negrin, Las Palmas de Gran Canarias, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Cabrera
authors.affiliation: Department of Pulmonology, University Clinic of Navarra, Pamplona, Spain.
authors.forename: Jorge
authors.initials: J
authors.lastname: Zagaceta
authors.affiliation: Department of Pulmonology, University Clinic of Navarra, Pamplona, Spain.
authors.forename: Pablo
authors.initials: P
authors.lastname: Sanchez-Salcedo
authors.affiliation: Department of Pulmonology, University Clinic of Navarra, Pamplona, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Berto
authors.affiliation: Pulmonary Department, Hospital Universitario La Candelaria, Universidad de La Laguna, Santa Cruz de Tenerife, Spain.
authors.forename: Rebeca Baz
authors.initials: RB
authors.lastname: Davila
authors.affiliation: Department of Pulmonology, University Clinic of Navarra, Pamplona, Spain.
authors.forename: Ana B
authors.initials: AB
authors.lastname: Alcaide
authors.affiliation: Division of Pulmonary and Critical Care Medicine, The Bay Pines Veterans Affairs Healthcare System, University of South Florida, Tampa, FL, USA.
authors.forename: Claudia
authors.initials: C
authors.lastname: Cote
authors.affiliation: Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Bartolome R
authors.initials: BR
authors.lastname: Celli
mesh_terms: D017677:Age Distribution; D000368:Aged; D016000:Cluster Analysis; D015331:Cohort Studies; D015897:Comorbidity; D018450:Disease Progression; D005260:Female; D006801:Humans; D007255:Information Services; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology* / Q000503:physiopathology*; D012042:Registries; D018570:Risk Assessment; D017678:Sex Distribution; D013223:Statistics as Topic; D016019:Survival Analysis