title: Frequency of comorbidities in chronic obstructive pulmonary disease, and impact on all-cause mortality: A population-based cohort study.
abstract: In chronic obstructive pulmonary disease (COPD), the role of specific comorbidities on all-cause mortality is of major interest particularly with a database representative of the beneficiaries covered by the French health system. We investigated the frequency and the role of major comorbidities on all-cause mortality in a population-based cohort of COPD patients, and whether this impact was modulated by gender.
  
  
  
  A historical cohort was identified in the French claims data. Patients aged ≥45 years were selected in 2006 from the French national claims data (1/97(th) random sample) by at least one of the following criteria: (a) COPD-related hospitalisations, (b) long-term disease status for COPD, (c) dispensations of bronchodilators. Cardiovascular diseases, diabetes, depression and cancer were defined by specific therapy and/or long-term disease status. The impact of comorbidities on mortality was investigated during a seven-year follow-up period (2007-2013), using Cox models.
  
  
  
  In 4,237 patients (mean age 68 years, 55% males, mean annual death-rate 4.9%), cardiovascular diseases, diabetes, depression and cancers were identified in 68.7%, 15.2%, 14.2% and 10.6% of patients, respectively. Associations with mortality were significant for cardiovascular diseases (HR = 1.2, 95%CI = [1.0-1.4]), diabetes (HR = 1.2, 95%CI = [1.0-1.4]), depression (HR = 1.4, 95%CI = [1.2-1.6]) and cancers (HR = 1.6, 95%CI = [1.4-1.9]), with no difference between genders.
  
  
  
  In the French population, major comorbidities are common in COPD, particularly cardiovascular diseases that occur in over two thirds of patients. The impact of comorbidities on mortality was not related to their prevalence, with cancer having the largest impact.
authors: HESPER 7425, Health Services and Performance Research, Université Claude Bernard Lyon, France; PELyon, PharmacoEpidemiologie Lyon, Lyon, France.
authors: Laurent
authors: L
authors: Laforest
authors: Respiratory and Intensive Care Medicine, Cochin Hospital Group, Paris Descartes University (EA2511), Paris, France.
authors: Nicolas
authors: N
authors: Roche
authors: Respiratory Medicine, Croix-Rousse University Hospital, Lyon, France.
authors: Gilles
authors: G
authors: Devouassoux
authors: HESPER 7425, Health Services and Performance Research, Université Claude Bernard Lyon, France; PELyon, PharmacoEpidemiologie Lyon, Lyon, France.
authors: Manon
authors: M
authors: Belhassen
authors: Respiratory Medicine, Creteil University Hospital, Creteil, France.
authors: Christos
authors: C
authors: Chouaid
authors: HESPER 7425, Health Services and Performance Research, Université Claude Bernard Lyon, France; PELyon, PharmacoEpidemiologie Lyon, Lyon, France.
authors: Marine
authors: M
authors: Ginoux
authors: HESPER 7425, Health Services and Performance Research, Université Claude Bernard Lyon, France; PELyon, PharmacoEpidemiologie Lyon, Lyon, France; Respiratory Medicine, Croix-Rousse University Hospital, Lyon, France. Electronic address: eric.van-ganse@univ-lyon1.fr.
authors: Eric
authors: E
authors: Van Ganse
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001993:Bronchodilator Agents / Q000600:supply & distribution; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000401:mortality; D015331:Cohort Studies; D015897:Comorbidity; D003863:Depression / Q000453:epidemiology / Q000401:mortality; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000401:mortality; D005260:Female; D005602:France / Q000453:epidemiology; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends*; D009369:Neoplasms / Q000453:epidemiology / Q000401:mortality; D015995:Prevalence; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology* / Q000401:mortality*; D012107:Research Design
chemical_list: D001993:Bronchodilator Agents
keywords: COPD; Claims data; Comorbidity; Gender; Mortality; Population-based cohort