Nirupama Putcha1, Meilan K Han2, Carlos H Martinez2, Marilyn G Foreman3, Antonio R Anzueto4, Richard Casaburi5, Michael H Cho6, Nicola A Hanania7, Craig P Hersh6, Gregory L Kinney8, Barry J Make9, Robert M Steiner10, Sharon M Lutz8, Byron M Thomashow11, Andre A Williams12, Surya P Bhatt13, Terri H Beaty14, Russell P Bowler9, Joe W Ramsdell15, Jeffrey L Curtis2, Douglas Everett12, John E Hokanson8, David A Lynch16, E Rand Sutherland9, Edwin K Silverman6, James D Crapo9, Robert A Wise1, Elizabeth A Regan17, Nadia N Hansel1. 1. Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, USA. 2. Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan, USA. 3. Divison of Pulmonary and Critical Care Medicine, Morehouse School of Medicine, Atlanta, GA, USA. 4. Pulmonary Section, Department of Medicine, University of Texas Health Science Center, and South Texas Veterans Health Care System, San Antonio, TX, USA. 5. Rehabilitation Clinical Trials Center, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California, USA. 6. Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA. 7. Section of Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine, Houston, Texas, USA. 8. Colorado School of Public Health, Aurora, Colorado, USA. 9. Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, Colorado, USA. 10. Department of Radiology, Temple University School of Medicine, Philadelphia, Pennsylvania, USA. 11. Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University, New York, New York, USA. 12. Division of Biostatistics and Bioinformatics, National Jewish Health, Denver, Colorado, USA. 13. Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama Birmingham, Birmingham, Alabama, USA. 14. Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. 15. Department of Medicine, University of California San Diego, San Diego, CA, USA. 16. Division of Radiology, National Jewish Health, Denver, Colorado, USA. 17. Department of Medicine, National Jewish Health, Denver, Colorado, USA.
Abstract
BACKGROUND: COPD patients have a great burden of comorbidity. However, it is not well established whether this is due to shared risk factors such as smoking, if they impact patients exercise capacity and quality of life, or whether there are racial disparities in their impact on COPD. METHODS: We analyzed data from 10,192 current and ex-smokers with (cases) and without COPD (controls) from the COPDGene® cohort to establish risk for COPD comorbidities adjusted for pertinent covariates. In adjusted models, we examined comorbidities prevalence and impact in African-Americans (AA) and Non-Hispanic Whites (NHW). RESULTS: Comorbidities are more common in COPD compared to those with normal spirometry (controls), and the risk persists after adjustments for covariates including pack-years smoked. After adjustment for confounders, eight conditions were independently associated with worse exercise capacity, quality of life and dyspnea. There were racial disparities in the impact of comorbidities on exercise capacity, dyspnea and quality of life, presence of osteoarthritis and gastroesophageal reflux disease having a greater negative impact on all three outcomes in AAs than NHWs (p<0.05 for all interaction terms). CONCLUSIONS: Individuals with COPD have a higher risk for comorbidities than controls, an important finding shown for the first time comprehensively after accounting for confounders. Individual comorbidities are associated with worse exercise capacity, quality of life, and dyspnea, in African-Americans compared to non-Hispanic Whites.
BACKGROUND:COPDpatients have a great burden of comorbidity. However, it is not well established whether this is due to shared risk factors such as smoking, if they impact patients exercise capacity and quality of life, or whether there are racial disparities in their impact on COPD. METHODS: We analyzed data from 10,192 current and ex-smokers with (cases) and without COPD (controls) from the COPDGene® cohort to establish risk for COPD comorbidities adjusted for pertinent covariates. In adjusted models, we examined comorbidities prevalence and impact in African-Americans (AA) and Non-Hispanic Whites (NHW). RESULTS: Comorbidities are more common in COPD compared to those with normal spirometry (controls), and the risk persists after adjustments for covariates including pack-years smoked. After adjustment for confounders, eight conditions were independently associated with worse exercise capacity, quality of life and dyspnea. There were racial disparities in the impact of comorbidities on exercise capacity, dyspnea and quality of life, presence of osteoarthritis and gastroesophageal reflux disease having a greater negative impact on all three outcomes in AAs than NHWs (p<0.05 for all interaction terms). CONCLUSIONS: Individuals with COPD have a higher risk for comorbidities than controls, an important finding shown for the first time comprehensively after accounting for confounders. Individual comorbidities are associated with worse exercise capacity, quality of life, and dyspnea, in African-Americans compared to non-Hispanic Whites.
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